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 17 * 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
J2820 - Injection, sargramostim (gm-csf), 50 mcg 50 MCG 59.883 - - - - - -
J2860 - Injection, siltuximab, 10 mg 10 MG 163.366 - - - - - -
J2865 - Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg 5MG-1MG 0.056 - - - - - -
J2916 - Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg 12.5 MG 1.935 - - - - - -
J2919 - Injection, methylprednisolone sodium succinate, 5 mg 5 MG 0.251 - - - - - -
J2997 - Injection, alteplase recombinant, 1 mg 1 MG 91.462 - - - - - -
J3000 - Injection, streptomycin, up to 1 gm 1 GM 25.589 - - - - - -
J3010 - Injection, fentanyl citrate, 0.1 mg 0.1 MG 0.839 - - - - - -
J3032 - Injection, eptinezumab-jjmr, 1 mg 1 MG 19.321 - - - - - -
J3055 - Injection, talquetamab-tgvs, 0.25 mg 0.25 MG 69.997 - - - - - -
J3060 - Injection, taliglucerase alfa, 10 units 10 UNITS 40.642 - - - - - -
J3090 - Injection, tedizolid phosphate, 1 mg 1 MG 1.801 - - - - - -
J3095 - Injection, telavancin, 10 mg 10 MG 7.09 - - - - - -
J3101 - Injection, tenecteplase, 1 mg 1 MG 162.456 - - - - - -
J3105 - Injection, terbutaline sulfate, up to 1 mg 1 MG 1.413 - - - - - -
J3111 - Injection, romosozumab-aqqg, 1 mg 1 MG 11.494 - - - - - -
J3121 - Injection, testosterone enanthate, 1 mg 1 MG 0.052 - - - - - -
J3145 - Injection, testosterone undecanoate, 1 mg 1 MG 2.022 - - - - - -
J3230 - Injection, chlorpromazine hcl, up to 50 mg 50 MG 29.038 - - - - - -
J3240 - Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial 0.9 MG 2078.711 - - - - - -
J3241 - Injection, teprotumumab-trbw, 10 mg 10 MG 352.563 - - - - - -
J3243 - Injection, tigecycline, 1 mg 1 MG 0.302 - - - - - -
J3245 - Injection, tildrakizumab, 1 mg 1 MG 131.462 - - - - - -
J3246 - Injection, tirofiban hcl, 0.25 mg 0.25 MG 3.549 - - - - - -
J3247 - Injection, secukinumab, intravenous, 1 mg 1 MG 17.728 - - - - - -
* 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