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 9 * 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
J1325 - Injection, epoprostenol, 0.5 mg 0.5 MG 16.075 - - - - - -
J1335 - Injection, ertapenem sodium, 500 mg 500 MG 9.182 - - - - - -
J1364 - Injection, erythromycin lactobionate, per 500 mg 500 MG 65.96 - - - - - -
J1380 - Injection, estradiol valerate, up to 10 mg 10 MG 7.301 - - - - - -
J1410 - Injection, estrogen conjugated, per 25 mg 25 MG 382.887 - - - - - -
J1430 - Injection, ethanolamine oleate, 100 mg 100 MG 497.7 - - - - - -
J1434 - Injection, fosaprepitant (focinvez), 1 mg 1 MG 3.021 - - - - - -
J1437 - Injection, ferric derisomaltose, 10 mg 10 MG 20.826 - - - - - -
J1439 - Injection, ferric carboxymaltose, 1 mg 1 MG 1.127 - - - - - -
J1440 - Fecal microbiota, live - jslm, 1 ml 1 ML 63.934 - - - - - -
J1442 - Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram 1 MCG 0.983 - - - - - -
J1447 - Injection, tbo-filgrastim, 1 microgram 1 MCG 0.366 - - - - - -
J1448 - Injection, trilaciclib, 1mg 1 MG 5.388 - - - - - -
J1449 - Injection, eflapegrastim-xnst, 0.1 mg 0.1 MG 22.608 - - - - - -
J1450 - Injection fluconazole, 200 mg 200 MG 3.577 - - - - - -
J1453 - Injection, fosaprepitant, 1 mg 1 MG 0.118 - - - - - -
J1454 - Injection, fosnetupitant 235 mg and palonosetron 0.25 mg 0.25 MG 632.875 - - - - - -
J1455 - Injection, foscarnet sodium, per 1000 mg 1000 MG 21.629 - - - - - -
J1456 - Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg 1 MG 1.214 - - - - - -
J1458 - Injection, galsulfase, 1 mg 1 MG 484.877 - - - - - -
J1459 - Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 49.179 - - - - - -
J1460 - Injection, gamma globulin, intramuscular, 1 cc 1 CC 48.885 - - - - - -
J1551 - Injection, immune globulin (cutaquig), 100 mg 100 MG 14.335 - - - - - -
J1552 - Injection, immune globulin (alyglo), 500 mg 500 MG 138.111 - - - - - -
J1554 - Injection, immune globulin (asceniv), 500 mg 500 MG 496.683 - - - - - -
* 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