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 37 * 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
Q9958 - High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml 1 ML 0.075 - - - - - -
Q9961 - High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml 1 ML 0.286 - - - - - -
Q9963 - High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml 1 ML 0.219 - - - - - -
Q9965 - Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml 1 ML 0.934 - - - - - -
Q9966 - Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml 1 ML 0.407 - - - - - -
Q9967 - Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 1 ML 0.143 - - - - - -
Q9991 - Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg Less than or equal to 100 MG 1925.231 - - - - - -
Q9992 - Injection, buprenorphine extended-release (sublocade), greater than 100 mg Greater than 100 MG 1925.231 - - - - - -
* 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