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 22 * 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
J7327 - Hyaluronan or derivative, monovisc, for intra-articular injection, per dose PER DOSE 528.576 - - - - - -
J7328 - Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg 0.1 MG 0.653 - - - - - -
J7329 - Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg 1 MG 5.445 - - - - - -
J7331 - Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg 1 MG 5.613 - - - - - -
J7332 - Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg 1 MG 10.164 - - - - - -
J7336 - Capsaicin 8% patch, per square centimeter 1 SQ CM 3.38 - - - - - -
J7340 - Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml 100 ML 243.148 - - - - - -
J7345 - Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg 10 MG 1.811 - - - - - -
J7351 - Injection, bimatoprost, intracameral implant, 1 microgram 1 MCG 212.364 - - - - - -
J7354 - Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) Per 3.2 mg single-use applicator 669.594 - - - - - -
J7355 - Injection, travoprost, intracameral implant, 1 microgram 1 MCG 195.252 - - - - - -
J7402 - Mometasone furoate sinus implant, (sinuva), 10 micrograms 10 MCG 11.345 - - - - - -
J7500 - Azathioprine, oral, 50 mg 50 MG 2.141 - - - - - -
J7502 - Cyclosporine, oral, 100 mg 100 MG 2.069 - - - - - -
J7503 - Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg 0.25 MG 1.833 - - - - - -
J7504 - Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg 250 MG 5013.11 - - - - - -
J7507 - Tacrolimus, immediate release, oral, 1 mg 1 MG 0.154 - - - - - -
J7508 - Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg 0.1 MG 0.586 - - - - - -
J7509 - Methylprednisolone oral, per 4 mg 4 MG 0.233 - - - - - -
J7510 - Prednisolone oral, per 5 mg 5 MG 0.273 - - - - - -
J7511 - Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg 25 MG 996.392 - - - - - -
J7512 - Prednisone, immediate release or delayed release, oral, 1 mg 1 MG 0.004 - - - - - -
J7515 - Cyclosporine, oral, 25 mg 25 MG 0.769 - - - - - -
J7516 - Injection, cyclosporine, 250 mg 250 MG 72.688 - - - - - -
J7517 - Mycophenolate mofetil, oral, 250 mg 250 MG 0.157 - - - - - -
* 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