Products billed under this code include Octreotide Acetate, Sandostatin Lar Depot.
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 |
|---|---|---|---|---|
| Octreotide Acetate | Teva Pharmaceuticals USA, Inc. | 00480-9257-08 | 10 | $2,113.21 |
| Octreotide Acetate | Teva Pharmaceuticals USA, Inc. | 00480-9259-08 | 20 | $4,226.42 |
| Octreotide Acetate | Teva Pharmaceuticals USA, Inc. | 00480-9262-08 | 30 | $6,339.63 |
| Octreotide Acetate | Mylan Institutional LLC | 67457-0756-10 | 10 | $2,113.21 |
| Octreotide Acetate | Mylan Institutional LLC | 67457-0759-20 | 20 | $4,226.42 |
| Octreotide Acetate | Mylan Institutional LLC | 67457-0762-30 | 30 | $6,339.63 |
| Sandostatin Lar Depot | Novartis Pharmaceuticals Corporation | 00078-0811-81 | 10 | $2,113.21 |
| Sandostatin Lar Depot | Novartis Pharmaceuticals Corporation | 00078-0818-81 | 20 | $4,226.42 |
| Sandostatin Lar Depot | Novartis Pharmaceuticals Corporation | 00078-0825-81 | 30 | $6,339.63 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $211.321 | +$3.226 | 1 MG | Octreotide injection, depot | v1, posted September 17, 2026 |
| 3Q26 | $208.095 | +$19.745 | 1 MG | Octreotide injection, depot | v1, posted September 15, 2026 |
| 2Q26 | $188.35 | −$10.82 | 1 MG | Octreotide injection, depot | v1, posted September 15, 2026 |
| 1Q26 | $199.17 | −$4.413 | 1 MG | Octreotide injection, depot | v1, posted September 15, 2026 |
| 4Q25 | $203.583 | −$8.616 | 1 MG | Octreotide injection, depot | v1, posted September 8, 2026 |
| 3Q25 | $212.199 | +$7.607 | 1 MG | Octreotide injection, depot | v1, posted March 10, 2026 |
| 2Q25 | $204.592 | −$13.779 | 1 MG | Octreotide injection, depot | v1, posted March 10, 2026 |
| 1Q25 | $218.371 | +$3.487 | 1 MG | Octreotide injection, depot | v1, posted December 19, 2025 |
| 4Q24 | $214.884 | −$0.599 | 1 MG | Octreotide injection, depot | v1, posted June 11, 2025 |
| 3Q24 | $215.483 | +$4.923 | 1 MG | Octreotide injection, depot | v1, posted June 11, 2025 |
| 2Q24 | $210.56 | −$0.269 | 1 MG | Octreotide injection, depot | v1, posted March 11, 2025 |
| 1Q24 | $210.829 | +$3.673 | 1 MG | Octreotide injection, depot | v1, posted December 19, 2024 |
| 4Q23 | $207.156 | −$0.961 | 1 MG | Octreotide injection, depot | v1, posted October 10, 2024 |
| 3Q23 | $208.117 | +$3.58 | 1 MG | Octreotide injection, depot | v1, posted June 5, 2024 |
| 2Q23 | $204.537 | −$1.108 | 1 MG | Octreotide injection, depot | v1, posted February 23, 2024 |
| 1Q23 | $205.645 | −$1.316 | 1 MG | Octreotide injection, depot | v1, posted December 6, 2023 |
| 4Q22 | $206.961 | −$0.546 | 1 MG | Octreotide injection, depot | v1, posted June 22, 2023 |
| 3Q22 | $207.507 | +$0.08 | 1 MG | Octreotide injection, depot | v1, posted June 9, 2023 |
| 2Q22 | $207.427 | +$0.865 | 1 MG | Octreotide injection, depot | v1, posted December 14, 2022 |
| 1Q22 | $206.562 | +$1.19 | 1 MG | Octreotide injection, depot | v1, posted June 8, 2022 |
| 4Q21 | $205.372 | +$1.43 | 1 MG | Octreotide injection, depot | v1, posted June 2, 2022 |
| 3Q21 | $203.942 | −$1.101 | 1 MG | Octreotide injection, depot | v1, posted June 2, 2022 |
| 2Q21 | $205.043 | −$0.369 | 1 MG | Octreotide injection, depot | v1, posted March 1, 2022 |
| 1Q21 | $205.412 | – | 1 MG | Octreotide injection, depot | 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.
