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 28 * 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
J9273 - Injection, tisotumab vedotin-tftv, 1 mg 1 MG 188.648 - - - - - -
J9274 - Injection, tebentafusp-tebn, 1 microgram 1 MCG 217.088 - - - - - -
J9276 - Injection, zanidatamab-hrii, 2 mg 2 MG 25.08 - - - - - -
J9280 - Injection, mitomycin, 5 mg 5 MG 28.272 - - - - - -
J9281 - Mitomycin pyelocalyceal instillation, 1 mg 1 MG 317.421 - - - - - -
J9286 - Injection, glofitamab-gxbm, 2.5 mg 2.5 MG 2770.569 - - - - - -
J9292 - Injection, pemetrexed dipotassium, 10 mg 10 MG 83.284 - - - - - -
J9293 - Injection, mitoxantrone hydrochloride, per 5 mg 5 MG 29.6 - - - - - -
J9294 - Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg 10 MG 4.925 - - - - - -
J9295 - Injection, necitumumab, 1 mg 1 MG 5.731 - - - - - -
J9296 - Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg 10 mg 9.736 - - - - - -
J9297 - Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg 10 MG 1.209 - - - - - -
J9298 - Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg 3 mg/1 mg 197.648 - - - - - -
J9299 - Injection, nivolumab, 1 mg 1 MG 33.002 - - - - - -
J9301 - Injection, obinutuzumab, 10 mg 10 MG 78.461 - - - - - -
J9303 - Injection, panitumumab, 10 mg 10 MG 172.549 - - - - - -
J9304 - Injection, pemetrexed (pemfexy), 10 mg 10 MG 52.742 - - - - - -
J9305 - Injection, pemetrexed, not otherwise specified, 10 mg 10 MG 3.734 - - - - - -
J9306 - Injection, pertuzumab, 1 mg 1 MG 16.892 - - - - - -
J9307 - Injection, pralatrexate, 1 mg 1 MG 388.825 - - - - - -
J9308 - Injection, ramucirumab, 5 mg 5 MG 74.453 - - - - - -
J9309 - Injection, polatuzumab vedotin-piiq, 1 mg 1 MG 136.23 - - - - - -
J9311 - Injection, rituximab 10 mg and hyaluronidase 10 mg 36.962 - - - - - -
J9312 - Injection, rituximab, 10 mg 10 MG 75.931 - - - - - -
J9314 - Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg 10 MG 3.791 - - - - - -
* 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