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 15 * 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
J2426 - Injection, paliperidone palmitate extended release (invega sustenna), 1 mg 1 MG 14.739 - - - - - -
J2427 - Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg 1MG 12.672 - - - - - -
J2430 - Injection, pamidronate disodium, per 30 mg 30 MG 13.876 - - - - - -
J2468 - Injection, palonosetron hydrochloride (posfrea), 25 micrograms 25 MCG 59.905 - - - - - -
J2469 - Injection, palonosetron hcl, 25 mcg 25 MCG 0.498 - - - - - -
J2501 - Injection, paricalcitol, 1 mcg 1 MCG 0.808 - - - - - -
J2502 - Injection, pasireotide long acting, 1 mg 1 MG 526.942 - - - - - -
J2506 - Injection, pegfilgrastim, excludes biosimilar, 0.5 mg 0.5 MG 19.981 - - - - - -
J2507 - Injection, pegloticase, 1 mg 1 MG 3565.318 - - - - - -
J2508 - Injection, pegunigalsidase alfa-iwxj, 1 mg 1 MG 226.927 - - - - - -
J2540 - Injection, penicillin g potassium, up to 600,000 units 600000 UNITS 0.775 - - - - - -
J2543 - Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) 1.125 GM 1.119 - - - - - -
J2545 - Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg 300 MG 79.497 - - - - - -
J2550 - Injection, promethazine hcl, up to 50 mg 50 MG 3.313 - - - - - -
J2560 - Injection, phenobarbital sodium, up to 120 mg 120 MG 29.436 - - - - - -
J2562 - Injection, plerixafor, 1 mg 1 MG 24.976 - - - - - -
J2597 - Injection, desmopressin acetate, per 1 mcg 1 MCG 4.488 - - - - - -
J2598 - Injection, vasopressin, 1 unit 1 UNIT 1.42 - - - - - -
J2599 - Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit 1 UNIT 1.332 - - - - - -
J2601 - Injection, vasopressin (baxter), 1 unit 1 UNIT 3.501 - - - - - -
J2675 - Injection, progesterone, per 50 mg 50 MG 0.659 - - - - - -
J2679 - Injection, fluphenazine hcl, 1.25 mg 1.25 MG 7.148 - - - - - -
J2680 - Injection, fluphenazine decanoate, up to 25 mg 25 MG 8.828 - - - - - -
J2690 - Injection, procainamide hcl, up to 1 gm 1 GM 284.337 - - - - - -
J2700 - Injection, oxacillin sodium, up to 250 mg 250 MG 0.636 - - - - - -
* 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