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 19 * 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
J3385 - Injection, velaglucerase alfa, 100 units 100 UNITS 380.183 - - - - - -
J3396 - Injection, verteporfin, 0.1 mg 0.1 MG 11.552 - - - - - -
J3401 - Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml 0.1 ML 1037.118 - - - - - -
J3410 - Injection, hydroxyzine hcl, up to 25 mg 25 MG 16.928 - - - - - -
J3411 - Injection, thiamine hcl, 100 mg 100 MG 1.787 - - - - - -
J3415 - Injection, pyridoxine hcl, 100 mg 100 MG 12.799 - - - - - -
J3420 - Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 1000 MCG 0.947 - - - - - -
J3425 - Injection, hydroxocobalamin, intramuscular, 10 mcg 10 MCG 0.008 - - - - - -
J3430 - Injection, phytonadione (vitamin k), per 1 mg 1 MG 2.844 - - - - - -
J3465 - Injection, voriconazole, 10 mg 10 MG 0.778 - - - - - -
J3470 - Injection, hyaluronidase, up to 150 units 150 UNITS 31.554 - - - - - -
J3471 - Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) 1 USP UNIT 0.499 - - - - - -
J3473 - Injection, hyaluronidase, recombinant, 1 usp unit 1 USP UNIT 0.363 - - - - - -
J3475 - Injection, magnesium sulfate, per 500 mg 500 MG 0.499 - - - - - -
J3480 - Injection, potassium chloride, per 2 meq 2 MEQ 0.169 - - - - - -
J3485 - Injection, zidovudine, 10 mg 10 MG 1.514 - - - - - -
J3486 - Injection, ziprasidone mesylate, 10 mg 10 MG 3.138 - - - - - -
J3489 - Injection, zoledronic acid, 1 mg 1 MG 5.203 - - - - - -
J7030 - Infusion, normal saline solution , 1000 cc 1000 CC 2.279 - - - - - -
J7040 - Infusion, normal saline solution, sterile (500 ml = 1 unit) 500 ML 1.376 - - - - - -
J7042 - 5% dextrose/normal saline (500 ml = 1 unit) 500 ML 1.355 - - - - - -
J7050 - Infusion, normal saline solution, 250 cc 250 CC 0.711 - - - - - -
J7060 - 5% dextrose/water (500 ml = 1 unit) 500 ML 2.026 - - - - - -
J7070 - Infusion, d5w, 1000 cc 1000 CC 3.041 - - - - - -
J7120 - Ringers lactate infusion, up to 1000 cc 1000 CC 2.462 - - - - - -
* 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