Naltrexone, depot form
Products billed under this code include Vivitrol.
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.Products billed under this code include Vivitrol.
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 |
|---|---|---|---|---|
| Vivitrol | Alkermes, Inc. | 65757-0300-01 | 380 | $1,724.06 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $4.537 | +$0.012 | 1 MG | Naltrexone, depot form | v1, posted September 17, 2026 |
| 3Q26 | $4.525 | +$0.279 | 1 MG | Naltrexone, depot form | v1, posted September 15, 2026 |
| 2Q26 | $4.246 | +$0.002 | 1 MG | Naltrexone, depot form | v1, posted September 15, 2026 |
| 1Q26 | $4.244 | +$0.004 | 1 MG | Naltrexone, depot form | v1, posted September 15, 2026 |
| 4Q25 | $4.24 | +$0.002 | 1 MG | Naltrexone, depot form | v1, posted September 8, 2026 |
| 3Q25 | $4.238 | +$0.115 | 1 MG | Naltrexone, depot form | v1, posted March 10, 2026 |
| 2Q25 | $4.123 | $0.00 | 1 MG | Naltrexone, depot form | v1, posted March 10, 2026 |
| 1Q25 | $4.123 | +$0.007 | 1 MG | Naltrexone, depot form | v1, posted December 19, 2025 |
| 4Q24 | $4.116 | +$0.02 | 1 MG | Naltrexone, depot form | v1, posted June 11, 2025 |
| 3Q24 | $4.096 | +$0.129 | 1 MG | Naltrexone, depot form | v1, posted June 11, 2025 |
| 2Q24 | $3.967 | +$0.008 | 1 MG | Naltrexone, depot form | v1, posted March 11, 2025 |
| 1Q24 | $3.959 | −$0.002 | 1 MG | Naltrexone, depot form | v1, posted December 19, 2024 |
| 4Q23 | $3.961 | +$0.021 | 1 MG | Naltrexone, depot form | v1, posted October 10, 2024 |
| 3Q23 | $3.94 | +$0.213 | 1 MG | Naltrexone, depot form | v1, posted June 5, 2024 |
| 2Q23 | $3.727 | −$0.009 | 1 MG | Naltrexone, depot form | v1, posted February 23, 2024 |
| 1Q23 | $3.736 | −$0.004 | 1 MG | Naltrexone, depot form | v1, posted December 6, 2023 |
| 4Q22 | $3.74 | +$0.203 | 1 MG | Naltrexone, depot form | v1, posted June 22, 2023 |
| 3Q22 | $3.537 | $0.00 | 1 MG | Naltrexone, depot form | v1, posted June 9, 2023 |
| 2Q22 | $3.537 | +$0.019 | 1 MG | Naltrexone, depot form | v1, posted December 14, 2022 |
| 1Q22 | $3.518 | −$0.009 | 1 MG | Naltrexone, depot form | v1, posted June 8, 2022 |
| 4Q21 | $3.527 | +$0.091 | 1 MG | Naltrexone, depot form | v1, posted June 2, 2022 |
| 3Q21 | $3.436 | +$0.01 | 1 MG | Naltrexone, depot form | v1, posted June 2, 2022 |
| 2Q21 | $3.426 | −$0.002 | 1 MG | Naltrexone, depot form | v1, posted March 1, 2022 |
| 1Q21 | $3.428 | – | 1 MG | Naltrexone, depot form | 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.