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 18 * 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
J3145 - Injection, testosterone undecanoate, 1 mg 1 MG 1.993 - - - - - -
J3230 - Injection, chlorpromazine hcl, up to 50 mg 50 MG 27.07 - - - - - -
J3240 - Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial 0.9 MG 2113.238 - - - - - -
J3241 - Injection, teprotumumab-trbw, 10 mg 10 MG 359.089 - - - - - -
J3243 - Injection, tigecycline, 1 mg 1 MG 0.507 - - - - - -
J3245 - Injection, tildrakizumab, 1 mg 1 MG 126.238 - - - - - -
J3246 - Injection, tirofiban hcl, 0.25 mg 0.25 MG 3.429 - - - - - -
J3247 - Injection, secukinumab, intravenous, 1 mg 1 MG 17.844 - - - - - -
J3250 - Injection, trimethobenzamide hcl, up to 200 mg 200 MG 53.401 - - - - - -
J3260 - Injection, tobramycin sulfate, up to 80 mg 80 MG 2.46 - - - - - -
J3262 - Injection, tocilizumab, 1 mg 1 MG 5.786 - - - - - -
J3263 - Injection, toripalimab-tpzi, 1 mg 1 MG 39.499 - - - - - -
J3285 - Injection, treprostinil, 1 mg 1 MG 55.483 - - - - - -
J3299 - Injection, triamcinolone acetonide (xipere), 1 mg 1 MG 48 - - - - - -
J3300 - Injection, triamcinolone acetonide, preservative free, 1 mg 1 MG 24.508 - - - - - -
J3301 - Injection, triamcinolone acetonide, not otherwise specified, 10 mg 10 MG 0.862 - - - - - -
J3304 - Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg 1 MG 18.209 - - - - - -
J3315 - Injection, triptorelin pamoate, 3.75 mg 3.75 MG 491.899 - - - - - -
J3316 - Injection, triptorelin, extended-release, 3.75 mg 3.75 MG 3772.85 - - - - - -
J3358 - Ustekinumab, for intravenous injection, 1 mg 1 MG 13.29 - - - - - -
J3360 - Injection, diazepam, up to 5 mg 5 MG 6.17 - - - - - -
J3373 - Injection, vancomycin hydrochloride, 10 mg 10 MG 0.031 - - - - - -
J3374 - Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg 10 MG 0.121 - - - - - -
J3375 - Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to j3373, 10 mg 10 MG 0.134 - - - - - -
J3380 - Injection, vedolizumab, intravenous, 1 mg 1 MG 22.062 - - - - - -
* 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