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 14 * 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
J2310 - Injection, naloxone hydrochloride, per 1 mg 1 MG 9.213 - - - - - -
J2311 - Injection, naloxone hydrochloride (zimhi), 1 mg 1 MG 1.495 - - - - - -
J2315 - Injection, naltrexone, depot form, 1 mg 1 MG 4.123 - - - - - -
J2323 - Injection, natalizumab, 1 mg 1 MG 24.368 - - - - - -
J2327 - Injection, risankizumab-rzaa, intravenous, 1 mg 1 MG 14.859 - - - - - -
J2329 - Injection, ublituximab-xiiy, 1mg 1 MG 68.655 - - - - - -
J2350 - Injection, ocrelizumab, 1 mg 1 MG 57.807 - - - - - -
J2351 - Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq 1 MG 45.187 - - - - - -
J2353 - Injection, octreotide, depot form for intramuscular injection, 1 mg 1 MG 204.592 - - - - - -
J2354 - Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg 25 MCG 0.59 - - - - - -
J2356 - Injection, tezepelumab-ekko, 1 mg 1 MG 17.767 - - - - - -
J2357 - Injection, omalizumab, 5 mg 5 MG 40.117 - - - - - -
J2358 - Injection, olanzapine, long-acting, 1 mg 1 MG 2.917 - - - - - -
J2359 - Injection, olanzapine, 0.5 mg 0.5 MG 0.928 - - - - - -
J2360 - Injection, orphenadrine citrate, up to 60 mg 60 MG 12.328 - - - - - -
J2371 - Injection, phenylephrine hydrochloride, 20 micrograms 20 MCG 0.002 - - - - - -
J2372 - Injection, phenylephrine hydrochloride (biorphen), 20 micrograms 20 MCG 0.175 - - - - - -
J2373 - Injection, phenylephrine hydrochloride (immphentiv), 20 micrograms 20 MCG 0.138 - - - - - -
J2401 - Injection, chloroprocaine hydrochloride, per 1 mg 1 MG 0.039 - - - - - -
J2403 - Chloroprocaine hcl ophthalmic, 3% gel, 1 mg 1 MG 0.604 - - - - - -
J2404 - Injection, nicardipine, 0.1 mg 0.1 MG 0.089 - - - - - -
J2405 - Injection, ondansetron hydrochloride, per 1 mg 1 MG 0.086 - - - - - -
J2406 - Injection, oritavancin (kimyrsa), 10 mg 10 MG 42.765 - - - - - -
J2407 - Injection, oritavancin (orbactiv), 10 mg 10 MG 28.525 - - - - - -
J2425 - Injection, palifermin, 50 micrograms 50 MCG 33.991 - - - - - -
* 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