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 38 * 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
`Q9950` - Injection, sulfur hexafluoride lipid microspheres, per ml	1 ML	18.591	-	-	-	-	-	-
`Q9956` - Injection, octafluoropropane microspheres, per ml	1 ML	41.2	-	-	-	-	-	-
`Q9957` - Injection, perflutren lipid microspheres, per ml	1 ML	41.2	-	-	-	-	-	-
`Q9958` - High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml	1 ML	0.074	-	-	-	-	-	-
`Q9961` - High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml	1 ML	0.285	-	-	-	-	-	-
`Q9963` - High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml	1 ML	0.217	-	-	-	-	-	-
`Q9965` - Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml	1 ML	1.801	-	-	-	-	-	-
`Q9966` - Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml	1 ML	0.445	-	-	-	-	-	-
`Q9967` - Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml	1 ML	0.151	-	-	-	-	-	-
`Q9991` - Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg	Less than or equal to 100 MG	1976.552	-	-	-	-	-	-
`Q9992` - Injection, buprenorphine extended-release (sublocade), greater than 100 mg	Greater than 100 MG	1976.552	-	-	-	-	-	-
* 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