Products billed under this code include Depo-Testosterone, Testosterone Cypionate.
Payment limit per 1 MG, 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 |
|---|---|---|---|---|
| Depo-Testosterone | Pfizer Inc | 00009-0085-10 | 1000 | $23.00 |
| Depo-Testosterone | Pfizer Inc | 00009-0086-01 | 200 | $4.60 |
| Depo-Testosterone | Pfizer Inc | 00009-0347-02 | 1000 | $23.00 |
| Depo-Testosterone | Pfizer Inc | 00009-0417-01 | 200 | $4.60 |
| Depo-Testosterone | Pfizer Inc | 00009-0417-02 | 2000 | $46.00 |
| Testosterone Cypionate | Hikma Pharmaceuticals USA Inc. | 00143-9005-01 | 2000 | $46.00 |
| Testosterone Cypionate | Hikma Pharmaceuticals USA Inc. | 00143-9659-01 | 200 | $4.60 |
| Testosterone Cypionate | Hikma Pharmaceuticals USA Inc. | 00143-9726-01 | 2000 | $46.00 |
| Testosterone Cypionate | Pfizer Inc | 00409-6557-01 | 1000 | $23.00 |
| Testosterone Cypionate | Pfizer Inc | 00409-6562-01 | 200 | $4.60 |
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Testosterone Cypionate | Pfizer Inc | 00409-6562-20 | 2000 | $46.00 |
| Testosterone Cypionate | Padagis US LLC | 00574-0820-01 | 200 | $4.60 |
| Testosterone Cypionate | Padagis US LLC | 00574-0820-10 | 2000 | $46.00 |
| Testosterone Cypionate | Padagis US LLC | 00574-0827-10 | 2000 | $46.00 |
| Testosterone Cypionate | Actavis Pharma, Inc. | 00591-4128-79 | 2000 | $46.00 |
| Testosterone Cypionate | Alvogen, Inc. | 47781-0910-91 | 20000 | $460.00 |
| Testosterone Cypionate | Alvogen, Inc. | 47781-0911-93 | 200 | $4.60 |
| Testosterone Cypionate | A-S Medication Solutions | 50090-4147-00 | 2000 | $46.00 |
| Testosterone Cypionate | A-S Medication Solutions | 50090-4446-00 | 2000 | $46.00 |
| Testosterone Cypionate | A-S Medication Solutions | 50090-4920-00 | 2000 | $46.00 |
| Testosterone Cypionate | A-S Medication Solutions | 50090-4921-00 | 2000 | $46.00 |
| Testosterone Cypionate | Eugia US LLC | 55150-0276-01 | 1000 | $23.00 |
| Testosterone Cypionate | Eugia US LLC | 55150-0277-01 | 200 | $4.60 |
| Testosterone Cypionate | Eugia US LLC | 55150-0278-01 | 2000 | $46.00 |
| Testosterone Cypionate | Cipla USA, Inc. | 69097-0536-37 | 1000 | $23.00 |
| Testosterone Cypionate | Cipla USA, Inc. | 69097-0537-31 | 200 | $4.60 |
| Testosterone Cypionate | Cipla USA, Inc. | 69097-0802-32 | 200 | $4.60 |
| Testosterone Cypionate | Cipla USA, Inc. | 69097-0802-37 | 2000 | $46.00 |
| Testosterone Cypionate | Xiromed, LLC | 70700-0288-22 | 1000 | $23.00 |
| Testosterone Cypionate | Xiromed, LLC | 70700-0289-22 | 200 | $4.60 |
| Testosterone Cypionate | Xiromed, LLC | 70700-0290-22 | 2000 | $46.00 |
| Testosterone Cypionate | Northstar RxLLC | 72603-0286-01 | 200 | $4.60 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $0.023 | −$0.002 | 1 MG | Inj testosterone cypionate | v1, posted September 17, 2026 |
| 3Q26 | $0.025 | +$0.001 | 1 MG | Inj testosterone cypionate | v1, posted September 15, 2026 |
| 2Q26 | $0.024 | −$0.003 | 1 MG | Inj testosterone cypionate | v1, posted September 15, 2026 |
| 1Q26 | $0.027 | −$0.001 | 1 MG | Inj testosterone cypionate | v1, posted September 15, 2026 |
| 4Q25 | $0.028 | −$0.003 | 1 MG | Inj testosterone cypionate | v1, posted September 8, 2026 |
| 3Q25 | $0.031 | +$0.001 | 1 MG | Inj testosterone cypionate | v1, posted March 10, 2026 |
| 2Q25 | $0.03 | −$0.002 | 1 MG | Inj testosterone cypionate | v1, posted March 10, 2026 |
| 1Q25 | $0.032 | $0.00 | 1 MG | Inj testosterone cypionate | v1, posted December 19, 2025 |
| 4Q24 | $0.032 | +$0.001 | 1 MG | Inj testosterone cypionate | v1, posted June 11, 2025 |
| 3Q24 | $0.031 | +$0.021 | 1 MG | Inj testosterone cypionate | v1, posted June 11, 2025 |
| 2Q24 | $0.01 | −$0.017 | 1 MG | Inj testosterone cypionate | v1, posted March 11, 2025 |
| 1Q24 | $0.027 | −$0.002 | 1 MG | Inj testosterone cypionate | v1, posted December 19, 2024 |
| 4Q23 | $0.029 | $0.00 | 1 MG | Inj testosterone cypionate | v1, posted October 10, 2024 |
| 3Q23 | $0.029 | $0.00 | 1 MG | Inj testosterone cypionate | v1, posted June 5, 2024 |
| 2Q23 | $0.029 | −$0.003 | 1 MG | Inj testosterone cypionate | v1, posted February 23, 2024 |
| 1Q23 | $0.032 | +$0.003 | 1 MG | Inj testosterone cypionate | v1, posted December 6, 2023 |
| 4Q22 | $0.029 | $0.00 | 1 MG | Inj testosterone cypionate | v1, posted June 22, 2023 |
| 3Q22 | $0.029 | +$0.001 | 1 MG | Inj testosterone cypionate | v1, posted June 9, 2023 |
| 2Q22 | $0.028 | +$0.002 | 1 MG | Inj testosterone cypionate | v1, posted December 14, 2022 |
| 1Q22 | $0.026 | −$0.003 | 1 MG | Inj testosterone cypionate | v1, posted June 8, 2022 |
| 4Q21 | $0.029 | +$0.001 | 1 MG | Inj testosterone cypionate | v1, posted June 2, 2022 |
| 3Q21 | $0.028 | $0.00 | 1 MG | Inj testosterone cypionate | v1, posted June 2, 2022 |
| 2Q21 | $0.028 | −$0.005 | 1 MG | Inj testosterone cypionate | v1, posted March 1, 2022 |
| 1Q21 | $0.033 | – | 1 MG | Inj testosterone cypionate | 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.
