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 24 * 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
J8530 - Cyclophosphamide; oral, 25 mg 25 MG 1.982 - - - - - -
J8540 - Dexamethasone, oral, 0.25 mg 0.25 MG 0.016 - - - - - -
J8560 - Etoposide; oral, 50 mg 50 MG 75.763 - - - - - -
J8610 - Methotrexate; oral, 2.5 mg 2.5 MG 0.198 - - - - - -
J8611 - Methotrexate (jylamvo), oral, 2.5 mg 2.5 MG 18.528 - - - - - -
J8612 - Methotrexate (xatmep), oral, 2.5 mg 2.5 MG 22.659 - - - - - -
J8655 - Netupitant 300 mg and palonosetron 0.5 mg, oral 0.5 MG 409.52 - - - - - -
J8670 - Rolapitant, oral, 1 mg 1 MG 1.559 - - - - - -
J8700 - Temozolomide, oral, 5 mg 5 MG 0.361 - - - - - -
J8705 - Topotecan, oral, 0.25 mg 0.25 mg 124.901 - - - - - -
J9000 - Injection, doxorubicin hydrochloride, 10 mg 10 MG 2.723 - - - - - -
J9017 - Injection, arsenic trioxide, 1 mg 1 MG 5.857 - - - - - -
J9021 - Injection, asparaginase, recombinant, (rylaze), 0.1 mg 0.1 MG 55.299 - - - - - -
J9022 - Injection, atezolizumab, 10 mg 10 MG 91.021 - - - - - -
J9023 - Injection, avelumab, 10 mg 10 MG 100.299 - - - - - -
J9024 - Injection, atezolizumab, 5 mg and hyaluronidase-tqjs 5 MG 31.635 - - - - - -
J9025 - Injection, azacitidine, 1 mg 1 MG 0.209 - - - - - -
J9026 - Injection, tarlatamab-dlle, 1 mg 1 MG 1567.493 - - - - - -
J9027 - Injection, clofarabine, 1 mg 1 MG 14.718 - - - - - -
J9028 - Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram 1 MCG 94.115 - - - - - -
J9029 - Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose PER THERAPEUTIC DOSE 63431.053 - - - - - -
J9030 - Bcg live intravesical instillation, 1 mg 1 MG 3.123 - - - - - -
J9032 - Injection, belinostat, 10 mg 10 MG 52.04 - - - - - -
J9033 - Injection, bendamustine hydrochloride, 1 mg 1 MG 1.85 - - - - - -
J9034 - Injection, bendamustine hcl (bendeka), 1 mg 1 MG 13.12 - - - - - -
* 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