Products billed under this code include Mycophenolic Acid, Mycophenolic Acid DR, Myfortic DR.
Payment limit per 180 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 |
|---|---|---|---|---|
| Mycophenolic Acid | Ascend Laboratories, LLC | 67877-0928-12 | 120 | $30.84 |
| Mycophenolic Acid | Ascend Laboratories, LLC | 67877-0929-12 | 240 | $61.68 |
| Mycophenolic Acid DR | Major Pharmaceuticals | 00904-6785-04 | 30 | $7.71 |
| Mycophenolic Acid DR | Major Pharmaceuticals | 00904-6785-61 | 100 | $25.70 |
| Mycophenolic Acid DR | Major Pharmaceuticals | 00904-6786-04 | 60 | $15.42 |
| Mycophenolic Acid DR | Major Pharmaceuticals | 00904-6786-61 | 200 | $51.40 |
| Mycophenolic Acid DR | Accord healthcare Inc | 16729-0261-29 | 120 | $30.84 |
| Mycophenolic Acid DR | TWI Pharmaceuticals, Inc. | 24979-0160-44 | 120 | $30.84 |
| Mycophenolic Acid DR | TWI Pharmaceuticals, Inc. | 24979-0161-44 | 240 | $61.68 |
| Mycophenolic Acid DR | A-S Medication Solutions | 50090-6492-00 | 360 | $92.52 |
| Product | Labeler | NDC | Units / pkg | Limit / pkg |
|---|---|---|---|---|
| Mycophenolic Acid DR | AvPAK | 50268-0559-12 | 20 | $5.14 |
| Mycophenolic Acid DR | Aurobindo Pharma Usa, Inc. | 59651-0621-08 | 120 | $30.84 |
| Mycophenolic Acid DR | Aurobindo Pharma Usa, Inc. | 59651-0622-08 | 240 | $61.68 |
| Mycophenolic Acid DR | Apotex Corp | 60505-2965-07 | 120 | $30.84 |
| Mycophenolic Acid DR | Apotex Corp | 60505-2966-07 | 240 | $61.68 |
| Mycophenolic Acid DR | Ascend Laboratories, LLC | 67877-0426-12 | 120 | $30.84 |
| Mycophenolic Acid DR | Ascend Laboratories, LLC | 67877-0427-12 | 240 | $61.68 |
| Mycophenolic Acid DR | American Health Packaging | 68084-0907-21 | 30 | $7.71 |
| Mycophenolic Acid DR | American Health Packaging | 68084-0918-25 | 60 | $15.42 |
| Mycophenolic Acid DR | Biocon Pharma Inc | 70377-0039-11 | 120 | $30.84 |
| Mycophenolic Acid DR | Biocon Pharma Inc | 70377-0040-11 | 240 | $61.68 |
| Mycophenolic Acid DR | Biocon Pharma Inc | 70377-0126-11 | 120 | $30.84 |
| Mycophenolic Acid DR | Biocon Pharma Inc | 70377-0127-11 | 240 | $61.68 |
| Mycophenolic Acid DR | Slate Run Pharmaceuticals | 70436-0172-23 | 120 | $30.84 |
| Mycophenolic Acid DR | Slate Run Pharmaceuticals | 70436-0173-23 | 240 | $61.68 |
| Mycophenolic Acid DR | Archis Pharma LLC | 72819-0155-08 | 120 | $30.84 |
| Mycophenolic Acid DR | Archis Pharma LLC | 72819-0156-08 | 240 | $61.68 |
| Myfortic DR | Novartis Pharmaceuticals Corporation | 00078-0385-66 | 120 | $30.84 |
| Myfortic DR | Novartis Pharmaceuticals Corporation | 00078-0386-66 | 240 | $61.68 |
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $0.257 | −$0.068 | 180 MG | Mycophenolic acid | v1, posted September 17, 2026 |
| 3Q26 | $0.325 | +$0.007 | 180 MG | Mycophenolic acid | v1, posted September 15, 2026 |
| 2Q26 | $0.318 | $0.00 | 180 MG | Mycophenolic acid | v1, posted September 15, 2026 |
| 1Q26 | $0.318 | −$0.019 | 180 MG | Mycophenolic acid | v1, posted September 15, 2026 |
| 4Q25 | $0.337 | −$0.032 | 180 MG | Mycophenolic acid | v1, posted September 8, 2026 |
| 3Q25 | $0.369 | −$0.01 | 180 MG | Mycophenolic acid | v1, posted March 10, 2026 |
| 2Q25 | $0.379 | −$0.099 | 180 MG | Mycophenolic acid | v1, posted March 10, 2026 |
| 1Q25 | $0.478 | +$0.036 | 180 MG | Mycophenolic acid | v1, posted December 19, 2025 |
| 4Q24 | $0.442 | +$0.068 | 180 MG | Mycophenolic acid | v1, posted June 11, 2025 |
| 3Q24 | $0.374 | −$0.124 | 180 MG | Mycophenolic acid | v1, posted June 11, 2025 |
| 2Q24 | $0.498 | −$0.13 | 180 MG | Mycophenolic acid | v1, posted March 11, 2025 |
| 1Q24 | $0.628 | −$0.245 | 180 MG | Mycophenolic acid | v1, posted December 19, 2024 |
| 4Q23 | $0.873 | +$0.201 | 180 MG | Mycophenolic acid | v1, posted October 10, 2024 |
| 3Q23 | $0.672 | +$0.029 | 180 MG | Mycophenolic acid | v1, posted June 5, 2024 |
| 2Q23 | $0.643 | −$0.128 | 180 MG | Mycophenolic acid | v1, posted February 23, 2024 |
| 1Q23 | $0.771 | −$0.295 | 180 MG | Mycophenolic acid | v1, posted December 6, 2023 |
| 4Q22 | $1.066 | −$0.117 | 180 MG | Mycophenolic acid | v1, posted June 22, 2023 |
| 3Q22 | $1.183 | +$0.009 | 180 MG | Mycophenolic acid | v1, posted June 9, 2023 |
| 2Q22 | $1.174 | −$0.426 | 180 MG | Mycophenolic acid | v1, posted December 14, 2022 |
| 1Q22 | $1.60 | +$0.039 | 180 MG | Mycophenolic acid | v1, posted June 8, 2022 |
| 4Q21 | $1.561 | +$0.098 | 180 MG | Mycophenolic acid | v1, posted June 2, 2022 |
| 3Q21 | $1.463 | −$0.659 | 180 MG | Mycophenolic acid | v1, posted June 2, 2022 |
| 2Q21 | $2.122 | −$0.056 | 180 MG | Mycophenolic acid | v1, posted March 1, 2022 |
| 1Q21 | $2.178 | – | 180 MG | Mycophenolic acid | 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.
