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 14 * 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
J2274 - Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg 10 MG 10.792 - - - - - -
J2277 - Injection, motixafortide, 0.25 mg 0.25 MG 25.218 - - - - - -
J2278 - Injection, ziconotide, 1 microgram 1 MCG 10.129 - - - - - -
J2280 - Injection, moxifloxacin, 100 mg 100 MG 8.711 - - - - - -
J2281 - Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg 100 MG 7.761 - - - - - -
J2290 - Injection, nafcillin sodium, 20 mg 20 MG 0.057 - - - - - -
J2300 - Injection, nalbuphine hydrochloride, per 10 mg 10 MG 3.514 - - - - - -
J2305 - Injection, nitroglycerin, 5 mg 5 MG 1.419 - - - - - -
J2312 - Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg 0.01 MG 0.068 - - - - - -
J2313 - Injection, naloxone hydrochloride (zimhi), 0.01 mg 0.01 MG 0.015 - - - - - -
J2315 - Injection, naltrexone, depot form, 1 mg 1 MG 4.238 - - - - - -
J2323 - Injection, natalizumab, 1 mg 1 MG 24.126 - - - - - -
J2327 - Injection, risankizumab-rzaa, intravenous, 1 mg 1 MG 14.84 - - - - - -
J2329 - Injection, ublituximab-xiiy, 1mg 1 MG 71.904 - - - - - -
J2350 - Injection, ocrelizumab, 1 mg 1 MG 59.704 - - - - - -
J2351 - Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq 1 MG 47.242 - - - - - -
J2353 - Injection, octreotide, depot form for intramuscular injection, 1 mg 1 MG 212.199 - - - - - -
J2354 - Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg 25 MCG 0.606 - - - - - -
J2356 - Injection, tezepelumab-ekko, 1 mg 1 MG 18.301 - - - - - -
J2357 - Injection, omalizumab, 5 mg 5 MG 40.563 - - - - - -
J2358 - Injection, olanzapine, long-acting, 1 mg 1 MG 2.917 - - - - - -
J2359 - Injection, olanzapine, 0.5 mg 0.5 MG 0.909 - - - - - -
J2360 - Injection, orphenadrine citrate, up to 60 mg 60 MG 9.448 - - - - - -
J2371 - Injection, phenylephrine hydrochloride, 20 micrograms 20 MCG 0.002 - - - - - -
J2372 - Injection, phenylephrine hydrochloride (biorphen), 20 micrograms 20 MCG 0.167 - - - - - -
* 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