Lorazepam injection
Products billed under this code include Ativan, Lorazepam.
Payment limit per 2 MG, by effective quarter, 1Q21 to 4Q26. Gaps mean the code was not in that quarter’s file, or CMS gave no payment limit.Products billed under this code include Ativan, Lorazepam.
Payment limit per 2 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 |
|---|---|---|---|---|
| Ativan | Hikma Pharmaceuticals USA Inc. | 00641-6000-10 | 100 | $219.70 |
| Ativan | Hikma Pharmaceuticals USA Inc. | 00641-6001-25 | 25 | $54.925 |
| Ativan | Hikma Pharmaceuticals USA Inc. | 00641-6002-10 | 200 | $439.40 |
| Ativan | Hikma Pharmaceuticals USA Inc. | 00641-6003-25 | 50 | $109.85 |
| Lorazepam | Pfizer Inc | 00409-1985-30 | 10 | $21.97 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6044-25 | 25 | $54.925 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6045-25 | 50 | $109.85 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6046-10 | 100 | $219.70 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6047-10 | 200 | $439.40 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6048-25 | 25 | $54.925 |
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6049-25 | 50 | $109.85 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6050-10 | 100 | $219.70 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6051-10 | 200 | $439.40 |
| Lorazepam | Hikma Pharmaceuticals USA Inc. | 00641-6207-25 | 25 | $54.925 |
| Lorazepam | FreseniUS Kabi USA, LLC | 65219-0368-02 | 25 | $54.925 |
| Lorazepam | Civica, Inc. | 72572-0380-25 | 25 | $54.925 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $2.197 | −$0.105 | 2 MG | Lorazepam injection | v1, posted September 17, 2026 |
| 3Q26 | $2.302 | +$0.642 | 2 MG | Lorazepam injection | v1, posted September 15, 2026 |
| 2Q26 | $1.66 | +$0.254 | 2 MG | Lorazepam injection | v1, posted September 15, 2026 |
| 1Q26 | $1.406 | +$0.029 | 2 MG | Lorazepam injection | v1, posted September 15, 2026 |
| 4Q25 | $1.377 | +$0.062 | 2 MG | Lorazepam injection | v1, posted September 8, 2026 |
| 3Q25 | $1.315 | −$0.25 | 2 MG | Lorazepam injection | v1, posted March 10, 2026 |
| 2Q25 | $1.565 | +$0.214 | 2 MG | Lorazepam injection | v1, posted March 10, 2026 |
| 1Q25 | $1.351 | −$0.105 | 2 MG | Lorazepam injection | v1, posted December 19, 2025 |
| 4Q24 | $1.456 | +$0.149 | 2 MG | Lorazepam injection | v1, posted June 11, 2025 |
| 3Q24 | $1.307 | +$0.345 | 2 MG | Lorazepam injection | v1, posted June 11, 2025 |
| 2Q24 | $0.962 | −$0.16 | 2 MG | Lorazepam injection | v1, posted March 11, 2025 |
| 1Q24 | $1.122 | +$0.112 | 2 MG | Lorazepam injection | v1, posted December 19, 2024 |
| 4Q23 | $1.01 | +$0.158 | 2 MG | Lorazepam injection | v1, posted October 10, 2024 |
| 3Q23 | $0.852 | −$0.327 | 2 MG | Lorazepam injection | v1, posted June 5, 2024 |
| 2Q23 | $1.179 | +$0.273 | 2 MG | Lorazepam injection | v1, posted February 23, 2024 |
| 1Q23 | $0.906 | −$0.051 | 2 MG | Lorazepam injection | v1, posted December 6, 2023 |
| 4Q22 | $0.957 | +$0.216 | 2 MG | Lorazepam injection | v1, posted June 22, 2023 |
| 3Q22 | $0.741 | +$0.015 | 2 MG | Lorazepam injection | v1, posted June 9, 2023 |
| 2Q22 | $0.726 | +$0.008 | 2 MG | Lorazepam injection | v1, posted December 14, 2022 |
| 1Q22 | $0.718 | −$0.063 | 2 MG | Lorazepam injection | v1, posted June 8, 2022 |
| 4Q21 | $0.781 | +$0.026 | 2 MG | Lorazepam injection | v1, posted June 2, 2022 |
| 3Q21 | $0.755 | +$0.045 | 2 MG | Lorazepam injection | v1, posted June 2, 2022 |
| 2Q21 | $0.71 | −$0.006 | 2 MG | Lorazepam injection | v1, posted March 1, 2022 |
| 1Q21 | $0.716 | – | 2 MG | Lorazepam injection | 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.