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 12 * 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
J1756 - Injection, iron sucrose, 1 mg 1 MG 0.224 - - - - - -
J1786 - Injection, imiglucerase, 10 units 10 UNITS 43.291 - - - - - -
J1790 - Injection, droperidol, up to 5 mg up to 5 MG 5.361 - - - - - -
J1805 - Injection, esmolol hydrochloride, 10 mg 10 MG 0.282 - - - - - -
J1806 - Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg 10 MG 0.417 - - - - - -
J1808 - Injection, folic acid, 0.1 mg 0.1 MG 0.058 - - - - - -
J1811 - Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 7.762 - - - - - -
J1813 - Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 15.272 - - - - - -
J1817 - Insulin for administration through dme (i.e., insulin pump) per 50 units 50 UNITS 3.237 - - - - - -
J1823 - Injection, inebilizumab-cdon, 1 mg 1 MG 494.434 - - - - - -
J1836 - Injection, metronidazole, 10 mg 10 MG 0.029 - - - - - -
J1885 - Injection, ketorolac tromethamine, per 15 mg 15 MG 0.346 - - - - - -
J1920 - Injection, labetalol hydrochloride, 5 mg 5 MG 0.389 - - - - - -
J1921 - Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg 5 MG 1.382 - - - - - -
J1930 - Injection, lanreotide, 1 mg 1 MG 36.657 - - - - - -
J1931 - Injection, laronidase, 0.1 mg 0.1 MG 39.881 - - - - - -
J1932 - Injection, lanreotide, (cipla), 1 mg 1 MG 24.45 - - - - - -
J1938 - Injection, furosemide, 1 mg 1 MG 0.021 - - - - - -
J1939 - Injection, bumetanide, 0.5 mg 0.5 MG 0.608 - - - - - -
J1943 - Injection, aripiprazole lauroxil, (aristada initio), 1 mg 1 MG 3.255 - - - - - -
J1944 - Injection, aripiprazole lauroxil, (aristada), 1 mg 1 MG 3.334 - - - - - -
J1950 - Injection, leuprolide acetate (for depot suspension), per 3.75 mg 3.75 MG 1737.097 - - - - - -
J1951 - Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg 0.25 MG 140.426 - - - - - -
J1952 - Leuprolide injectable, camcevi, 1 mg 1 mg 51.405 - - - - - -
J1953 - Injection, levetiracetam, 10 mg 10 MG 0.047 - - - - - -
* 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