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 24 * 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
J9017 - Injection, arsenic trioxide, 1 mg 1 MG 4.79 - - - - - -
J9021 - Injection, asparaginase, recombinant, (rylaze), 0.1 mg 0.1 MG 54.378 - - - - - -
J9022 - Injection, atezolizumab, 10 mg 10 MG 89.394 - - - - - -
J9023 - Injection, avelumab, 10 mg 10 MG 97.137 - - - - - -
J9024 - Injection, atezolizumab, 5 mg and hyaluronidase-tqjs 5 MG 30.876 - - - - - -
J9025 - Injection, azacitidine, 1 mg 1 MG 0.315 - - - - - -
J9026 - Injection, tarlatamab-dlle, 1 mg 1 MG 1570.765 - - - - - -
J9027 - Injection, clofarabine, 1 mg 1 MG 16.006 - - - - - -
J9028 - Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram 1 MCG 94.581 - - - - - -
J9029 - Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose PER THERAPEUTIC DOSE 63235.607 - - - - - -
J9030 - Bcg live intravesical instillation, 1 mg 1 MG 3.139 - - - - - -
J9032 - Injection, belinostat, 10 mg 10 MG 50.919 - - - - - -
J9033 - Injection, bendamustine hydrochloride, 1 mg 1 MG 1.24 - - - - - -
J9034 - Injection, bendamustine hcl (bendeka), 1 mg 1 MG 13.581 - - - - - -
J9035 - Injection, bevacizumab, 10 mg 10 MG 72.728 - - - - - -
J9036 - Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg 1 MG 14.196 - - - - - -
J9039 - Injection, blinatumomab, 1 microgram 1 MCG 152.276 - - - - - -
J9040 - Injection, bleomycin sulfate, 15 units 15 UNITS 21.556 - - - - - -
J9041 - Injection, bortezomib, 0.1 mg 0.1 MG 2.498 - - - - - -
J9042 - Injection, brentuximab vedotin, 1 mg 1 MG 248.93 - - - - - -
J9043 - Injection, cabazitaxel, 1 mg 1 MG 221.705 - - - - - -
J9045 - Injection, carboplatin, 50 mg 50 MG 2.93 - - - - - -
J9047 - Injection, carfilzomib, 1 mg 1 MG 51.847 - - - - - -
J9049 - Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg 0.1 MG 1.434 - - - - - -
J9050 - Injection, carmustine, 100 mg 100 MG 145.597 - - - - - -
* 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