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 19 * 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
J3430 - Injection, phytonadione (vitamin k), per 1 mg 1 MG 2.445 - - - - - -
J3465 - Injection, voriconazole, 10 mg 10 MG 1.061 - - - - - -
J3470 - Injection, hyaluronidase, up to 150 units 150 UNITS 32.168 - - - - - -
J3471 - Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) 1 USP UNIT 0.499 - - - - - -
J3473 - Injection, hyaluronidase, recombinant, 1 usp unit 1 USP UNIT 0.364 - - - - - -
J3475 - Injection, magnesium sulfate, per 500 mg 500 MG 0.494 - - - - - -
J3480 - Injection, potassium chloride, per 2 meq 2 MEQ 0.207 - - - - - -
J3485 - Injection, zidovudine, 10 mg 10 MG 1.513 - - - - - -
J3486 - Injection, ziprasidone mesylate, 10 mg 10 MG 5.183 - - - - - -
J3489 - Injection, zoledronic acid, 1 mg 1 MG 9.523 - - - - - -
J7030 - Infusion, normal saline solution , 1000 cc 1000 CC 2.469 - - - - - -
J7040 - Infusion, normal saline solution, sterile (500 ml = 1 unit) 500 ML 1.235 - - - - - -
J7042 - 5% dextrose/normal saline (500 ml = 1 unit) 500 ML 1.254 - - - - - -
J7050 - Infusion, normal saline solution, 250 cc 250 CC 0.618 - - - - - -
J7060 - 5% dextrose/water (500 ml = 1 unit) 500 ML 1.82 - - - - - -
J7070 - Infusion, d5w, 1000 cc 1000 CC 3.641 - - - - - -
J7120 - Ringers lactate infusion, up to 1000 cc 1000 CC 2.303 - - - - - -
J7170 - Injection, emicizumab-kxwh, 0.5 mg 0.5 MG 51.984 - - - - - - 1
J7171 - Injection, adamts13, recombinant-krhn, 10 iu 10 UNITS 34.516 - - - - - -
J7175 - Injection, factor x, (human), 1 i.u. 1 IU 9.533 - - - - - - 1
J7177 - Injection, human fibrinogen concentrate (fibryga), 1 mg 1 MG 1.101 - - - - - - 1
J7178 - Injection, human fibrinogen concentrate, not otherwise specified, 1 mg 1 MG 1.484 - - - - - - 1
J7179 - Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco 1 IU 1.831 - - - - - - 1
J7180 - Injection, factor xiii (antihemophilic factor, human), 1 i.u. 1 IU 10.477 - - - - - - 1
J7181 - Injection, factor xiii a-subunit, (recombinant), per iu 1 IU 17.336 - - - - - - 1
* 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