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 13 * 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
J2021 - Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg 200 MG 6.338 - - - - - -
J2060 - Injection, lorazepam, 2 mg 2 MG 1.565 - - - - - -
J2150 - Injection, mannitol, 25% in 50 ml 50 ML 2.263 - - - - - -
J2175 - Injection, meperidine hydrochloride, per 100 mg 100 MG 10.136 - - - - - -
J2182 - Injection, mepolizumab, 1 mg 1 MG 30.54 - - - - - -
J2183 - Injection, meropenem (wg critical care), not therapeutically equivalent to j2185, 100 mg 100 MG 1.604 - - - - - -
J2184 - Injection, meropenem (b. braun), not therapeutically equivalent to j2185, 100 mg 100 MG 2.085 - - - - - -
J2185 - Injection, meropenem, 100 mg 100 MG 0.431 - - - - - -
J2210 - Injection, methylergonovine maleate, up to 0.2 mg 0.2 MG 21.285 - - - - - -
J2246 - Injection, micafungin in sodium (baxter), not therapeutically equivalent to j2248, 1 mg 1 MG 0.638 - - - - - -
J2247 - Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg 1 MG 0.305 - - - - - -
J2248 - Injection, micafungin sodium, 1 mg 1 MG 0.282 - - - - - -
J2250 - Injection, midazolam hydrochloride, per 1 mg 1 MG 0.129 - - - - - -
J2251 - Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg 1 MG 0.17 - - - - - -
J2260 - Injection, milrinone lactate, 5 mg 5 MG 1.571 - - - - - -
J2267 - Injection, mirikizumab-mrkz, 1 mg 1 MG 47.566 - - - - - -
J2270 - Injection, morphine sulfate, up to 10 mg 10 MG 4.632 - - - - - -
J2272 - Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg 10 MG 6.637 - - - - - -
J2274 - Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg 10 MG 9.821 - - - - - -
J2277 - Injection, motixafortide, 0.25 mg 0.25 MG 25.218 - - - - - -
J2278 - Injection, ziconotide, 1 microgram 1 MCG 9.698 - - - - - -
J2280 - Injection, moxifloxacin, 100 mg 100 MG 8.574 - - - - - -
J2281 - Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg 100 MG 7.103 - - - - - -
J2300 - Injection, nalbuphine hydrochloride, per 10 mg 10 MG 3.08 - - - - - -
J2305 - Injection, nitroglycerin, 5 mg 5 MG 1.34 - - - - - -
* 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