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 11 * 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
J1631 - Injection, haloperidol decanoate, per 50 mg 50 MG 4.611 - - - - - -
J1640 - Injection, hemin, 1 mg 1 MG 33.073 - - - - - -
J1642 - Injection, heparin sodium, (heparin lock flush), per 10 units 10 UNITS 0.018 - - - - - -
J1643 - Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units 1000 UNITS 2.942 - - - - - -
J1644 - Injection, heparin sodium, per 1000 units 1000 UNITS 0.219 - - - - - -
J1645 - Injection, dalteparin sodium, per 2500 iu 2500 IU 16.043 - - - - - -
J1650 - Injection, enoxaparin sodium, 10 mg 10 MG 0.516 - - - - - -
J1652 - Injection, fondaparinux sodium, 0.5 mg 0.5 MG 0.855 - - - - - -
J1670 - Injection, tetanus immune globulin, human, up to 250 units 250 UNITS 575.76 - - - - - -
J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg 100 MG 20.58 - - - - - -
J1740 - Injection, ibandronate sodium, 1 mg 1 MG 22.219 - - - - - -
J1741 - Injection, ibuprofen, 100 mg 100 MG 2.975 - - - - - -
J1743 - Injection, idursulfase, 1 mg 1 MG 542.574 - - - - - -
J1744 - Injection, icatibant, 1 mg 1 MG 125.317 - - - - - -
J1745 - Injection, infliximab, excludes biosimilar, 10 mg 10 MG 30.523 - - - - - -
J1746 - Injection, ibalizumab-uiyk, 10 mg 10 MG 76.95 - - - - - -
J1747 - Injection, spesolimab-sbzo, 1 mg 1 MG 61.428 - - - - - -
J1750 - Injection, iron dextran, 50 mg 50 MG 17.233 - - - - - -
J1756 - Injection, iron sucrose, 1 mg 1 MG 0.237 - - - - - -
J1786 - Injection, imiglucerase, 10 units 10 UNITS 43.141 - - - - - -
J1790 - Injection, droperidol, up to 5 mg up to 5 MG 8.565 - - - - - -
J1805 - Injection, esmolol hydrochloride, 10 mg 10 MG 0.282 - - - - - -
J1806 - Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg 10 MG 0.41 - - - - - -
J1808 - Injection, folic acid, 0.1 mg 0.1 MG 0.063 - - - - - -
J1811 - Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 6.668 - - - - - -
* 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