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 26 * 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
J9177 - Injection, enfortumab vedotin-ejfv, 0.25 mg 0.25 MG 36.642 - - - - - -
J9178 - Injection, epirubicin hcl, 2 mg 2 MG 1.616 - - - - - -
J9179 - Injection, eribulin mesylate, 0.1 mg 0.1 MG 118.749 - - - - - -
J9181 - Injection, etoposide, 10 mg 10 MG 1.067 - - - - - -
J9185 - Injection, fludarabine phosphate, 50 mg 50 MG 59.529 - - - - - -
J9190 - Injection, fluorouracil, 500 mg 500 MG 2.206 - - - - - -
J9196 - Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg 200 MG 8.653 - - - - - -
J9200 - Injection, floxuridine, 500 mg 500 MG 3988.333 - - - - - -
J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg 200 MG 2.976 - - - - - -
J9202 - Goserelin acetate implant, per 3.6 mg 3.6 MG 705.141 - - - - - -
J9203 - Injection, gemtuzumab ozogamicin, 0.1 mg 0.1 MG 233.119 - - - - - -
J9204 - Injection, mogamulizumab-kpkc, 1 mg 1 MG 243.625 - - - - - -
J9205 - Injection, irinotecan liposome, 1 mg 1 MG 65.278 - - - - - -
J9206 - Injection, irinotecan, 20 mg 20 MG 1.64 - - - - - -
J9207 - Injection, ixabepilone, 1 mg 1 MG 136.207 - - - - - -
J9208 - Injection, ifosfamide, 1 gram 1 GM 24.618 - - - - - -
J9209 - Injection, mesna, 200 mg 200 MG 1.36 - - - - - -
J9210 - Injection, emapalumab-lzsg, 1 mg 1 MG 381.503 - - - - - -
J9211 - Injection, idarubicin hydrochloride, 5 mg 5 MG 43.505 - - - - - -
J9217 - Leuprolide acetate (for depot suspension), 7.5 mg 7.5 MG 172.288 - - - - - -
J9223 - Injection, lurbinectedin, 0.1 mg 0.1 MG 205.036 - - - - - -
J9226 - Histrelin implant (supprelin la), 50 mg 50 MG 45212.04 - - - - - -
J9227 - Injection, isatuximab-irfc, 10 mg 10 MG 78.855 - - - - - -
J9228 - Injection, ipilimumab, 1 mg 1 MG 180.215 - - - - - -
J9229 - Injection, inotuzumab ozogamicin, 0.1 mg 0.1 MG 2658.129 - - - - - -
* 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