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 16 * 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
J2704 - Injection, propofol, 10 mg 10 MG 0.093 - - - - - -
J2720 - Injection, protamine sulfate, per 10 mg 10 MG 1.398 - - - - - -
J2724 - Injection, protein c concentrate, intravenous, human, 10 iu 10 UNITS 15.024 - - - - - -
J2760 - Injection, phentolamine mesylate, up to 5 mg 5 MG 449.299 - - - - - -
J2765 - Injection, metoclopramide hcl, up to 10 mg 10 MG 1.125 - - - - - -
J2777 - Injection, faricimab-svoa, 0.1 mg 0.1 MG 34.722 - - - - - -
J2778 - Injection, ranibizumab, 0.1 mg 0.1 mg 90.414 - - - - - -
J2779 - Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg 0.1 MG 79.737 - - - - - -
J2781 - Injection, pegcetacoplan, intravitreal, 1 mg 1 MG 143.989 - - - - - -
J2782 - Injection, avacincaptad pegol, 0.1 mg 0.1 MG 107.444 - - - - - -
J2783 - Injection, rasburicase, 0.5 mg 0.5 MG 370.456 - - - - - -
J2785 - Injection, regadenoson, 0.1 mg 0.1 MG 4.411 - - - - - -
J2786 - Injection, reslizumab, 1 mg 1 MG 10.494 - - - - - -
J2788 - Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) 50 MCG (250 IU) 23.618 - - - - - -
J2790 - Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) 300 MCG (1500 IU) 77.158 - - - - - -
J2791 - Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu 100 IU 4.884 - - - - - -
J2792 - Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu 100 IU 32.507 - - - - - -
J2794 - Injection, risperidone (risperdal consta), 0.5 mg 0.5 MG 10.499 - - - - - -
J2795 - Injection, ropivacaine hydrochloride, 1 mg 1 MG 0.055 - - - - - -
J2798 - Injection, risperidone, (perseris), 0.5 mg 0.5 mg 12.154 - - - - - -
J2799 - Injection, risperidone (uzedy), 1 mg 1 MG 24.622 - - - - - -
J2800 - Injection, methocarbamol, up to 10 ml 10 ML 6.359 - - - - - -
J2802 - Injection, romiplostim, 1 microgram 1 MCG 10.516 - - - - - -
J2804 - Injection, rifampin, 1 mg 1 MG 0.142 - - - - - -
J2805 - Injection, sincalide, 5 micrograms 5 MCG 143.258 - - - - - -
* 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