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 7 * 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
J0878 - Injection, daptomycin, 1 mg 1 MG 0.033 - - - - - -
J0881 - Injection, darbepoetin alfa, 1 microgram (non-esrd use) 1 MCG 2.918 - - - - - -
J0882 - Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) 1 MCG 2.918 - - - - - -
J0883 - Injection, argatroban, 1 mg (for non-esrd use) 1 MG 0.95 - - - - - -
J0884 - Injection, argatroban, 1 mg (for esrd on dialysis) 1 MG 0.95 - - - - - -
J0885 - Injection, epoetin alfa, (for non-esrd use), 1000 units 1000 UNITS 7.08 - - - - - -
J0887 - Injection, epoetin beta, 1 microgram, (for esrd on dialysis) 1 MCG 1.26 - - - - - -
J0888 - Injection, epoetin beta, 1 microgram, (for non esrd use) 1 MCG 1.26 - - - - - -
J0893 - Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mg 1 MG 0.777 - - - - - -
J0894 - Injection, decitabine, 1 mg 1 MG 1.765 - - - - - -
J0895 - Injection, deferoxamine mesylate, 500 mg 500 MG 8.208 - - - - - -
J0896 - Injection, luspatercept-aamt, 0.25 mg 0.25 MG 41.243 - - - - - -
J0897 - Injection, denosumab, 1 mg 1 MG 27.809 - - - - - -
J0898 - Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) 1 MG 1.338 - - - - - -
J0899 - Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) 1 MG 1.338 - - - - - -
J1000 - Injection, depo-estradiol cypionate, up to 5 mg 5 MG 42.323 - - - - - -
J1010 - Injection, methylprednisolone acetate, 1 mg 1 MG 0.11 - - - - - -
J1071 - Injection, testosterone cypionate, 1 mg 1 MG 0.03 - - - - - -
J1096 - Dexamethasone, lacrimal ophthalmic insert, 0.1 mg 0.1 MG 110.68 - - - - - -
J1100 - Injection, dexamethasone sodium phosphate, 1 mg 1 MG 0.093 - - - - - -
J1110 - Injection, dihydroergotamine mesylate, per 1 mg 1 MG 85.747 - - - - - -
J1120 - Injection, acetazolamide sodium, up to 500 mg 500 MG 19.061 - - - - - -
J1160 - Injection, digoxin, up to 0.5 mg 0.5 MG 4.88 - - - - - -
J1162 - Injection, digoxin immune fab (ovine), per vial PER VIAL 4968.58 - - - - - -
J1165 - Injection, phenytoin sodium, per 50 mg 50 MG 0.522 - - - - - -
* 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