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 15 * 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
J2373 - Injection, phenylephrine hydrochloride (immphentiv), 20 micrograms 20 MCG 0.129 - - - - - -
J2401 - Injection, chloroprocaine hydrochloride, per 1 mg 1 MG 0.039 - - - - - -
J2403 - Chloroprocaine hcl ophthalmic, 3% gel, 1 mg 1 MG 0.599 - - - - - -
J2404 - Injection, nicardipine, 0.1 mg 0.1 MG 0.086 - - - - - -
J2405 - Injection, ondansetron hydrochloride, per 1 mg 1 MG 0.092 - - - - - -
J2406 - Injection, oritavancin (kimyrsa), 10 mg 10 MG 41.404 - - - - - -
J2407 - Injection, oritavancin (orbactiv), 10 mg 10 MG 28.521 - - - - - -
J2425 - Injection, palifermin, 50 micrograms 50 MCG 35.914 - - - - - -
J2426 - Injection, paliperidone palmitate extended release (invega sustenna), 1 mg 1 MG 15.084 - - - - - -
J2427 - Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg 1MG 12.955 - - - - - -
J2430 - Injection, pamidronate disodium, per 30 mg 30 MG 11.16 - - - - - -
J2468 - Injection, palonosetron hydrochloride (posfrea), 25 micrograms 25 MCG 58.835 - - - - - -
J2469 - Injection, palonosetron hcl, 25 mcg 25 MCG 0.445 - - - - - -
J2501 - Injection, paricalcitol, 1 mcg 1 MCG 0.671 - - - - - -
J2502 - Injection, pasireotide long acting, 1 mg 1 MG 563.79 - - - - - -
J2506 - Injection, pegfilgrastim, excludes biosimilar, 0.5 mg 0.5 MG 58.399 - - - - - -
J2507 - Injection, pegloticase, 1 mg 1 MG 3638.863 - - - - - -
J2508 - Injection, pegunigalsidase alfa-iwxj, 1 mg 1 MG 230.278 - - - - - -
J2540 - Injection, penicillin g potassium, up to 600,000 units 600000 UNITS 0.879 - - - - - -
J2543 - Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) 1.125 GM 1.108 - - - - - -
J2545 - Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg 300 MG 82.37 - - - - - -
J2550 - Injection, promethazine hcl, up to 50 mg 50 MG 2.867 - - - - - -
J2560 - Injection, phenobarbital sodium, up to 120 mg 120 MG 27.362 - - - - - -
J2562 - Injection, plerixafor, 1 mg 1 MG 119.469 - - - - - -
J2597 - Injection, desmopressin acetate, per 1 mcg 1 MCG 3.894 - - - - - -
* 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