Inj, polatuzumab vedotin 1mg
Products billed under this code include Polivy.
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 J9309
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 |
|---|---|---|---|---|
| Polivy | Genentech, Inc. | 50242-0103-01 | 30 | $4,323.09 |
| Polivy | Genentech, Inc. | 50242-0105-01 | 140 | $20,174.42 |
Every quarter
| Quarter | Payment limit | Change | Billing unit | Description | Source file |
|---|---|---|---|---|---|
| 4Q26 | $144.103 | +$0.492 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted September 17, 2026 |
| 3Q26 | $143.611 | +$6.384 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted September 15, 2026 |
| 2Q26 | $137.227 | +$0.455 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted September 15, 2026 |
| 1Q26 | $136.772 | +$0.106 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted September 15, 2026 |
| 4Q25 | $136.666 | +$0.436 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted September 8, 2026 |
| 3Q25 | $136.23 | +$3.505 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted March 10, 2026 |
| 2Q25 | $132.725 | −$0.191 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted March 10, 2026 |
| 1Q25 | $132.916 | +$3.135 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted December 19, 2025 |
| 4Q24 | $129.781 | −$0.176 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 11, 2025 |
| 3Q24 | $129.957 | +$5.924 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 11, 2025 |
| 2Q24 | $124.033 | −$0.256 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted March 11, 2025 |
| 1Q24 | $124.289 | +$3.055 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted December 19, 2024 |
| 4Q23 | $121.234 | −$0.018 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted October 10, 2024 |
| 3Q23 | $121.252 | +$3.138 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 5, 2024 |
| 2Q23 | $118.114 | $0.00 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted February 23, 2024 |
| 1Q23 | $118.114 | $0.00 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted December 6, 2023 |
| 4Q22 | $118.114 | +$0.305 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 22, 2023 |
| 3Q22 | $117.809 | +$4.238 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 9, 2023 |
| 2Q22 | $113.571 | $0.00 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted December 14, 2022 |
| 1Q22 | $113.571 | $0.00 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 8, 2022 |
| 4Q21 | $113.571 | $0.00 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 2, 2022 |
| 3Q21 | $113.571 | $0.00 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted June 2, 2022 |
| 2Q21 | $113.571 | +$1.456 | 1 MG | Inj, polatuzumab vedotin 1mg | v1, posted March 1, 2022 |
| 1Q21 | $112.115 | – | 1 MG | Inj, polatuzumab vedotin 1mg | 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.
CMS source files
- 4Q26: 2026-09-17_october-2026-medicare-part-b-payment-limit-files-final.zipposted September 17, 2026
- 4Q26: 2026-09-17_october-2026-ndc-hcpcs-crosswalk-final.zipposted September 17, 2026
- 3Q26: 2026-09-15_july-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 2Q26: 2026-09-15_april-2026-medicare-part-b-payment-limit-files-final-file.zipposted September 15, 2026
- 1Q26: 2026-09-15_january-2026-medicare-part-b-payment-limit-files.zipposted September 15, 2026
- 4Q25: 2026-09-08_october-2025-asp-pricing-final-file.zipposted September 8, 2026
- 3Q25: 2026-03-10_july-2025-asp-pricing-file.zipposted March 10, 2026
- 2Q25: 2026-03-10_april-2025-asp-pricing-file.zipposted March 10, 2026
- 1Q25: 2025-12-19_january-2025-asp-pricing-file-03-11-25-final-file.zipposted December 19, 2025
- 4Q24: 2025-06-11_october-2024-asp-pricing-file.zipposted June 11, 2025
- 3Q24: 2025-06-11_july-2024-asp-pricing-file.zipposted June 11, 2025
- 2Q24: 2025-03-11_april-2024-asp-pricing-file.zipposted March 11, 2025
- 1Q24: 2024-12-19_january-2024-asp-pricing-file.zipposted December 19, 2024
- 4Q23: 2024-10-10_october-2023-asp-pricing-file.zipposted October 10, 2024
- 3Q23: 2024-06-05_july-2023-asp-pricing-file.zipposted June 5, 2024
- 2Q23: 2024-02-23_april-2023-asp-pricing-file.zipposted February 23, 2024
- 1Q23: 2023-12-06_january-2023-asp-pricing-file.zipposted December 6, 2023
- 4Q22: 2023-06-22_october-2022-asp-pricing-file.zipposted June 22, 2023
- 3Q22: 2023-06-09_july-2022-asp-pricing-file.zipposted June 9, 2023
- 2Q22: 2022-12-14_april-2022-asp-pricing-file.zipposted December 14, 2022
- 1Q22: 2022-06-08_january-2022-asp-pricing-file.zipposted June 8, 2022
- 4Q21: 2022-06-02_october-2021-asp-pricing-file.zipposted June 2, 2022
- 3Q21: 2022-06-02_july-2021-asp-pricing-file.zipposted June 2, 2022
- 2Q21: 2022-03-01_april-2021-asp-pricing-file.zipposted March 1, 2022
- 1Q21: 2021-12-10_january-2021-asp-pricing-file.zipposted December 10, 2021