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 36 * 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
Q5112 - Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg 10 MG 28.74 - - - - - -
Q5113 - Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg 10 MG 73.905 - - - - - -
Q5114 - Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg 10 MG 46.816 - - - - - -
Q5115 - Injection, rituximab-abbs, biosimilar, (truxima), 10 mg 10 MG 34.759 - - - - - -
Q5116 - Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg 10 MG 24.931 - - - - - -
Q5117 - Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg 10 MG 27.905 - - - - - -
Q5118 - Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg 10 MG 26.943 - - - - - -
Q5119 - Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg 10 MG 24.943 - - - - - -
Q5120 - Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg 0.5 MG 24.711 - - - - - -
Q5121 - Injection, infliximab-axxq, biosimilar, (avsola), 10 mg 10 MG 19.749 - - - - - -
Q5122 - Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg 0.5 MG 134.252 - - - - - -
Q5123 - Injection, rituximab-arrx, biosimilar, (riabni), 10 mg 10 MG 33.087 - - - - - -
Q5124 - Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg 0.1 MG 85.569 - - - - - -
Q5125 - Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram 1 MCG 0.425 - - - - - -
Q5126 - Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg 10 MG 46.054 - - - - - -
Q5127 - Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg 0.5 MG 251.245 - - - - - -
Q5128 - Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg 0.1 MG 146.761 - - - - - -
Q5129 - Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg 10 MG 48.08 - - - - - -
Q5130 - Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg 0.5 MG 164.154 - - - - - -
Q5133 - Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg 1 MG 5.971 - - - - - -
Q5135 - Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg 1 MG 4.065 - - - - - -
Q5147 - Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg 1 MG 795.861 - - - - - -
Q9950 - Injection, sulfur hexafluoride lipid microspheres, per ml 1 ML 18.723 - - - - - -
Q9956 - Injection, octafluoropropane microspheres, per ml 1 ML 41.881 - - - - - -
Q9957 - Injection, perflutren lipid microspheres, per ml 1 ML 41.881 - - - - - -
* 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