Part B buy-and-bill runs on a razor-thin spread. Medicare pays ASP + 6%, and after the 2% sequester you net closer to ASP + 4.3%. Enter your acquisition cost and see, per J-code, exactly where you profit and where you are underwater.
Medicare's Part B payment limit is ASP + 6%, but the 2% federal sequester trims the Medicare-paid share, so your real add-on lands closer to ASP + 4.3% at standard 20% coinsurance. If your acquisition cost drifts above that net, you are billing the drug at a loss and rarely notice, because the loss hides inside a busy J-code line. One mispriced infusion across a month of units can quietly erase the margin on everything else.
We load the public CMS Average Sales Price payment-limit file, updated quarterly, for every Part B J-code and its ASP + 6% allowed amount.
We apply the 2% sequester to the Medicare-paid share to get your true net, then subtract the acquisition cost you enter on-device to show per-unit margin.
We rank by real spread, surface the J-codes where you lose money per unit, and model your monthly and annual margin before you renegotiate acquisition.
Open Drug Margin, enter your acquisition cost, and see the real net spread on every J-code you infuse. Free, on public CMS rates.
