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 17 * 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
J2794 - Injection, risperidone (risperdal consta), 0.5 mg 0.5 MG 10.941 - - - - - -
J2795 - Injection, ropivacaine hydrochloride, 1 mg 1 MG 0.061 - - - - - -
J2798 - Injection, risperidone, (perseris), 0.5 mg 0.5 mg 12.137 - - - - - -
J2799 - Injection, risperidone (uzedy), 1 mg 1 MG 25.075 - - - - - -
J2800 - Injection, methocarbamol, up to 10 ml 10 ML 4.786 - - - - - -
J2802 - Injection, romiplostim, 1 microgram 1 MCG 10.996 - - - - - -
J2804 - Injection, rifampin, 1 mg 1 MG 0.158 - - - - - -
J2805 - Injection, sincalide, 5 micrograms 5 MCG 135.973 - - - - - -
J2820 - Injection, sargramostim (gm-csf), 50 mcg 50 MCG 56.091 - - - - - -
J2860 - Injection, siltuximab, 10 mg 10 MG 161.955 - - - - - -
J2865 - Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg 5MG-1MG 0.051 - - - - - -
J2916 - Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg 12.5 MG 2.179 - - - - - -
J2919 - Injection, methylprednisolone sodium succinate, 5 mg 5 MG 0.259 - - - - - -
J2997 - Injection, alteplase recombinant, 1 mg 1 MG 94.152 - - - - - -
J3000 - Injection, streptomycin, up to 1 gm 1 GM 31.353 - - - - - -
J3010 - Injection, fentanyl citrate, 0.1 mg 0.1 MG 0.964 - - - - - -
J3032 - Injection, eptinezumab-jjmr, 1 mg 1 MG 19.847 - - - - - -
J3055 - Injection, talquetamab-tgvs, 0.25 mg 0.25 MG 72.396 - - - - - -
J3060 - Injection, taliglucerase alfa, 10 units 10 UNITS 41.064 - - - - - -
J3090 - Injection, tedizolid phosphate, 1 mg 1 MG 1.913 - - - - - -
J3095 - Injection, telavancin, 10 mg 10 MG 7.467 - - - - - -
J3101 - Injection, tenecteplase, 1 mg 1 MG 171.938 - - - - - -
J3105 - Injection, terbutaline sulfate, up to 1 mg 1 MG 2.742 - - - - - -
J3111 - Injection, romosozumab-aqqg, 1 mg 1 MG 12.004 - - - - - -
J3121 - Injection, testosterone enanthate, 1 mg 1 MG 0.055 - - - - - -
* 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