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 21 * 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
J7212 - Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram 1 MCG 2.385 - - - - - - 1
J7213 - Injection, coagulation factor ix (recombinant), ixinity, 1 i.u. 1 IU 1.923 - - - - - - 1
J7214 - Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u. 1 IU 4.596 - - - - - - 1
J7308 - Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) 354 MG 394.413 - - - - - -
J7311 - Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg 0.01 MG 340.036 - - - - - -
J7312 - Injection, dexamethasone, intravitreal implant, 0.1 mg 0.1 MG 205.236 - - - - - -
J7313 - Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg 0.01 MG 490.765 - - - - - -
J7314 - Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg 0.01 MG 524.568 - - - - - -
J7318 - Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg 1 MG 6.931 - - - - - -
J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg 1 MG 6.314 - - - - - -
J7321 - Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose per dose 73.96 - - - - - -
J7322 - Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg 1 MG 17.503 - - - - - -
J7323 - Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose per dose 128.709 - - - - - -
J7324 - Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose PER DOSE 125.299 - - - - - -
J7325 - Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg 1 MG 9.252 - - - - - -
J7326 - Hyaluronan or derivative, gel-one, for intra-articular injection, per dose per dose 538.48 - - - - - -
J7327 - Hyaluronan or derivative, monovisc, for intra-articular injection, per dose PER DOSE 663.641 - - - - - -
J7328 - Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg 0.1 MG 0.592 - - - - - -
J7329 - Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg 1 MG 5.586 - - - - - -
J7331 - Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg 1 MG 8.431 - - - - - -
J7332 - Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg 1 MG 10.281 - - - - - -
J7336 - Capsaicin 8% patch, per square centimeter 1 SQ CM 3.377 - - - - - -
J7340 - Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml 100 ML 235.772 - - - - - -
J7345 - Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg 10 MG 1.783 - - - - - -
J7351 - Injection, bimatoprost, intracameral implant, 1 microgram 1 MCG 209.907 - - - - - -
* 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