Products billed under this code include Polocaine, Polocaine - Mpf, Polocaine-Mpf.
Payment limit per 10 ML, by effective quarter, 1Q21 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.From the 4Q26 NDC–HCPCS crosswalk. “Limit / pkg” is the 4Q26 payment limit times the billing units in one package.
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Polocaine | A-S Medication Solutions | 50090-4408-00 | 5 | $21.835 |
| Polocaine | A-S Medication Solutions | 50090-4517-00 | 5 | $21.835 |
| Polocaine | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1534-03 | 125 | $545.875 |
| Polocaine | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1535-03 | 125 | $545.875 |
| Polocaine | FreseniUS Kabi USA, LLC | 63323-0283-57 | 125 | $545.875 |
| Polocaine | FreseniUS Kabi USA, LLC | 63323-0296-57 | 125 | $545.875 |
| Polocaine - Mpf | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1403-03 | 3 | $13.101 |
| Polocaine-Mpf | HF Acquisition Co. LLC, DBA HealthFirst | 51662-1403-01 | 3 | $13.101 |
| Polocaine-Mpf | FreseniUS Kabi USA, LLC | 63323-0260-37 | 75 | $327.525 |
| Polocaine-Mpf | FreseniUS Kabi USA, LLC | 63323-0293-37 | 75 | $327.525 |
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Polocaine-Mpf | FreseniUS Kabi USA, LLC | 63323-0294-27 | 50 | $218.35 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $4.367 | +$0.22 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted September 17, 2026 |
| 3Q26 | $4.147 | +$0.416 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted September 15, 2026 |
| 2Q26 | $3.731 | −$0.019 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted September 15, 2026 |
| 1Q26 | $3.75 | −$0.204 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted September 15, 2026 |
| 4Q25 | $3.954 | +$0.131 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted September 8, 2026 |
| 3Q25 | $3.823 | +$0.196 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted March 10, 2026 |
| 2Q25 | $3.627 | +$0.073 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted March 10, 2026 |
| 1Q25 | $3.554 | +$0.066 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted December 19, 2025 |
| 4Q24 | $3.488 | +$0.107 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 11, 2025 |
| 3Q24 | $3.381 | −$0.176 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 11, 2025 |
| 2Q24 | $3.557 | +$0.267 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted March 11, 2025 |
| 1Q24 | $3.29 | +$0.837 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted December 19, 2024 |
| 4Q23 | $2.453 | −$0.624 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted October 10, 2024 |
| 3Q23 | $3.077 | −$0.397 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 5, 2024 |
| 2Q23 | $3.474 | +$0.634 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted February 23, 2024 |
| 1Q23 | $2.84 | −$0.297 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted December 6, 2023 |
| 4Q22 | $3.137 | −$0.006 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 22, 2023 |
| 3Q22 | $3.143 | +$0.193 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 9, 2023 |
| 2Q22 | $2.95 | +$0.024 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted December 14, 2022 |
| 1Q22 | $2.926 | +$0.165 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 8, 2022 |
| 4Q21 | $2.761 | −$0.03 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 2, 2022 |
| 3Q21 | $2.791 | −$0.571 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted June 2, 2022 |
| 2Q21 | $3.362 | +$0.354 | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted March 1, 2022 |
| 1Q21 | $3.008 | – | 10 ML | Inj mepivacaine hcl/10 ml | v1, posted December 10, 2021 |
“Change” is the difference from the previous quarter, shown only when both quarters have a payment limit and the billing unit is the same. “vs. last quarter” and “vs. a year ago” follow the same rule.
