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 27 * 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
J9206 - Injection, irinotecan, 20 mg 20 MG 1.397 - - - - - -
J9207 - Injection, ixabepilone, 1 mg 1 MG 138.672 - - - - - -
J9208 - Injection, ifosfamide, 1 gram 1 GM 23.497 - - - - - -
J9209 - Injection, mesna, 200 mg 200 MG 1.334 - - - - - -
J9210 - Injection, emapalumab-lzsg, 1 mg 1 MG 381.64 - - - - - -
J9211 - Injection, idarubicin hydrochloride, 5 mg 5 MG 37.048 - - - - - -
J9217 - Leuprolide acetate (for depot suspension), 7.5 mg 7.5 MG 155.419 - - - - - -
J9223 - Injection, lurbinectedin, 0.1 mg 0.1 MG 206.125 - - - - - -
J9226 - Histrelin implant (supprelin la), 50 mg 50 MG 45560.391 - - - - - -
J9227 - Injection, isatuximab-irfc, 10 mg 10 MG 82.86 - - - - - -
J9228 - Injection, ipilimumab, 1 mg 1 MG 183.414 - - - - - -
J9229 - Injection, inotuzumab ozogamicin, 0.1 mg 0.1 MG 2698.053 - - - - - -
J9245 - Injection, melphalan hydrochloride, not otherwise specified, 50 mg 50 MG 108.03 - - - - - -
J9246 - Injection, melphalan (evomela), 1 mg 1 MG 17.372 - - - - - -
J9248 - Injection, melphalan (hepzato), 1 mg 1 MG 787.788 - - - - - -
J9260 - Injection, methotrexate sodium, 50 mg 50 MG 2.263 - - - - - -
J9261 - Injection, nelarabine, 50 mg 50 MG 63.379 - - - - - -
J9263 - Injection, oxaliplatin, 0.5 mg 0.5 MG 0.091 - - - - - -
J9264 - Injection, paclitaxel protein-bound particles, 1 mg 1 MG 12.122 - - - - - -
J9266 - Injection, pegaspargase, per single dose vial 1 EA 28424.059 - - - - - -
J9267 - Injection, paclitaxel, 1 mg 1 MG 0.106 - - - - - -
J9268 - Injection, pentostatin, 10 mg 10 MG 2543.894 - - - - - -
J9269 - Injection, tagraxofusp-erzs, 10 micrograms 10 MCG 348.616 - - - - - -
J9271 - Injection, pembrolizumab, 1 mg 1 MG 58.562 - - - - - -
J9272 - Injection, dostarlimab-gxly, 10 mg 10 MG 243.823 - - - - - -
* 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