ASP Drug Pricing - (3rd Quarter)
July 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jan 2025 (1st 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 10 * Effective Jul 1, 2025 through Sep 30, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1456 - Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg 1 MG 1.13 - - - - - -
J1458 - Injection, galsulfase, 1 mg 1 MG 505.505 - - - - - -
J1459 - Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 50.432 - - - - - -
J1460 - Injection, gamma globulin, intramuscular, 1 cc 1 CC 48.423 - - - - - -
J1551 - Injection, immune globulin (cutaquig), 100 mg 100 MG 14.207 - - - - - -
J1552 - Injection, immune globulin (alyglo), 500 mg 500 MG 131.122 - - - - - -
J1554 - Injection, immune globulin (asceniv), 500 mg 500 MG 496.505 - - - - - -
J1555 - Injection, immune globulin (cuvitru), 100 mg 100 MG 17.589 - - - - - -
J1556 - Injection, immune globulin (bivigam), 500 mg 500 MG 77.266 - - - - - -
J1557 - Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 62.466 - - - - - -
J1558 - Injection, immune globulin (xembify), 100 mg 100 MG 14.911 - - - - - -
J1559 - Injection, immune globulin (hizentra), 100 mg 100 MG 14.123 - - - - - -
J1560 - Injection, gamma globulin, intramuscular, over 10 cc 10 CC 167.062 - - - - - -
J1561 - Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg 500 MG 48.03 - - - - - -
J1566 - Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg 500 MG 81.702 - - - - - -
J1568 - Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 48.376 - - - - - -
J1569 - Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg 500 MG 47.797 - - - - - -
J1570 - Injection, ganciclovir sodium, 500 mg 500 MG 39.619 - - - - - -
J1571 - Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml 0.5 ML 71.663 - - - - - -
J1573 - Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml 0.5 ML 71.663 - - - - - -
J1575 - Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin 100 MG 18.386 - - - - - -
J1576 - Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 74.457 - - - - - -
J1580 - Injection, garamycin, gentamicin, up to 80 mg 80 MG 2.615 - - - - - -
J1596 - Injection, glycopyrrolate, 0.1 mg 0.1 MG 0.433 - - - - - -
J1598 - Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg 0.1 MG 1.852 - - - - - -
* Effective Jul 1, 2025 through Sep 30, 2025

Drugs not otherwise classified - July 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective Jul 1, 2025 through Sep 30, 2025

Drug name Dosage Payment limit Notes
Vasopressin (Long Grove) 1 UNIT 2.796

ASP (Average Sale Price) Drug Pricing History