ASP Drug Pricing - (2nd Quarter)
April 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2024 (4th Quarter) ASP data.
  • Note 2: The absence or presence of a HCPCS code and the payment allowance limits in this table does not indicate Medicare coverage of the drug. Similarly, the inclusion of a payment allowance limit within a specific column does not indicate Medicare coverage of the drug in that specific category. These determinations shall be made by the local Medicare contractor processing the claim.
 
Page 10 * Effective April 1, 2025 through June 30, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1555 - Injection, immune globulin (cuvitru), 100 mg 100 MG 16.682 - - - - - -
J1556 - Injection, immune globulin (bivigam), 500 mg 500 MG 77.298 - - - - - -
J1557 - Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 57.476 - - - - - -
J1558 - Injection, immune globulin (xembify), 100 mg 100 MG 14.283 - - - - - -
J1559 - Injection, immune globulin (hizentra), 100 mg 100 MG 13.644 - - - - - -
J1560 - Injection, gamma globulin, intramuscular, over 10 cc 10 CC 488.853 - - - - - -
J1561 - Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg 500 MG 48.345 - - - - - -
J1566 - Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg 500 MG 81.011 - - - - - -
J1568 - Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 48.055 - - - - - -
J1569 - Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg 500 MG 45.129 - - - - - -
J1570 - Injection, ganciclovir sodium, 500 mg 500 MG 32.086 - - - - - -
J1571 - Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml 0.5 ML 65.146 - - - - - -
J1573 - Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml 0.5 ML 65.146 - - - - - -
J1575 - Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin 100 MG 17.565 - - - - - -
J1576 - Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 70.432 - - - - - -
J1580 - Injection, garamycin, gentamicin, up to 80 mg 80 MG 2.467 - - - - - -
J1596 - Injection, glycopyrrolate, 0.1 mg 0.1 MG 0.509 - - - - - -
J1598 - Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg 0.1 MG 1.659 - - - - - -
J1602 - Injection, golimumab, 1 mg, for intravenous use 1 MG 10.769 - - - - - -
J1610 - Injection, glucagon hydrochloride, per 1 mg 1 MG 190.763 - - - - - -
J1611 - Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg 1 MG 150.437 - - - - - -
J1626 - Injection, granisetron hydrochloride, 100 mcg 100 MCG 0.261 - - - - - -
J1627 - Injection, granisetron, extended-release, 0.1 mg 0.1 MG 5.286 - - - - - -
J1628 - Injection, guselkumab, 1 mg 1 MG 70.427 - - - - - -
J1630 - Injection, haloperidol, up to 5 mg 5 MG 0.776 - - - - - -
* Effective April 1, 2025 through June 30, 2025

Drugs not otherwise classified - April 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective April 1, 2025 through June 30, 2025

Drug name Dosage Payment limit Notes
Diltiazem Hydrochloride 5 MG 0.416
Metoprolol Tartrate 1 MG 0.123
Vasopressin (Long Grove) 1 UNIT 3.272 Added April 2025

ASP (Average Sale Price) Drug Pricing History