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 25 * 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
J9055 - Injection, cetuximab, 10 mg 10 MG 77.524 - - - - - -
J9056 - Injection, bendamustine hydrochloride (vivimusta), 1 mg 1 MG 27.243 - - - - - -
J9060 - Injection, cisplatin, powder or solution, 10 mg 10 MG 2.86 - - - - - -
J9061 - Injection, amivantamab-vmjw, 2 mg 2 MG 21.507 - - - - - -
J9063 - Injection, mirvetuximab soravtansine-gynx, 1 mg 1 MG 68.074 - - - - - -
J9065 - Injection, cladribine, per 1 mg 1 MG 10.202 - - - - - -
J9071 - Injection, cyclophosphamide (auromedics), 5 mg 5 MG 0.869 - - - - - -
J9072 - Injection, cyclophosphamide (frindovyx), 5 mg 5 MG 9.053 - - - - - -
J9073 - Injection, cyclophosphamide (dr. reddy's), 5 mg 5 MG 1.762 - - - - - -
J9074 - Injection, cyclophosphamide (sandoz), 5 mg 5 MG 4.344 - - - - - -
J9075 - Injection, cyclophosphamide, not otherwise specified, 5 mg 5 MG 0.799 - - - - - -
J9100 - Injection, cytarabine, 100 mg 100 MG 0.813 - - - - - -
J9118 - Injection, calaspargase pegol-mknl, 10 units 10 UNIT 76.527 - - - - - -
J9119 - Injection, cemiplimab-rwlc, 1 mg 1 MG 28.921 - - - - - -
J9120 - Injection, dactinomycin, 0.5 mg 0.5 MG 288.796 - - - - - -
J9130 - Dacarbazine, 100 mg 100 MG 4.503 - - - - - -
J9144 - Injection, daratumumab, 10 mg and hyaluronidase-fihj 10 MG 52.992 - - - - - -
J9145 - Injection, daratumumab, 10 mg 10 MG 67.625 - - - - - -
J9150 - Injection, daunorubicin, 10 mg 10 MG 26.397 - - - - - -
J9153 - Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine 1 MG/2.27 MG 249.021 - - - - - -
J9155 - Injection, degarelix, 1 mg 1 MG 4.357 - - - - - -
J9171 - Injection, docetaxel, 1 mg 1 MG 0.611 - - - - - -
J9172 - Injection, docetaxel (docivyx), 1 mg 1 MG 51.62 - - - - - -
J9173 - Injection, durvalumab, 10 mg 10 MG 83.868 - - - - - -
J9176 - Injection, elotuzumab, 1 mg 1 MG 7.732 - - - - - -
* 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