ASP Drug Pricing - (4th Quarter)
October 2024
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Apr 2024 (2nd 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 12 * Effective October 1, 2024 - December 31, 2024
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J2175 - Injection, meperidine hydrochloride, per 100 mg 100 MG 6.517 - - - - - -
J2182 - Injection, mepolizumab, 1 mg 1 MG 30.435 - - - - - -
J2183 - Injection, meropenem (wg critical care), not therapeutically equivalent to j2185, 100 mg 100 MG 1.617 - - - - - -
J2184 - Injection, meropenem (b. braun), not therapeutically equivalent to j2185, 100 mg 100 MG 2.103 - - - - - -
J2185 - Injection, meropenem, 100 mg 100 MG 0.354 - - - - - -
J2210 - Injection, methylergonovine maleate, up to 0.2 mg 0.2 MG 22.436 - - - - - -
J2247 - Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg 1 MG 0.346 - - - - - -
J2248 - Injection, micafungin sodium, 1 mg 1 MG 0.285 - - - - - -
J2250 - Injection, midazolam hydrochloride, per 1 mg 1 MG 0.13 - - - - - -
J2251 - Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg 1 MG 0.177 - - - - - -
J2260 - Injection, milrinone lactate, 5 mg 5 MG 1.413 - - - - - -
J2267 - Injection, mirikizumab-mrkz, 1 mg 1 MG 39.542 - - - - - -
J2270 - Injection, morphine sulfate, up to 10 mg 10 MG 4.841 - - - - - -
J2272 - Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg 10 MG 5.07 - - - - - -
J2274 - Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg 10 MG 10.463 - - - - - -
J2277 - Injection, motixafortide, 0.25 mg 0.25 MG 25.218 - - - - - -
J2278 - Injection, ziconotide, 1 microgram 1 MCG 9.649 - - - - - -
J2280 - Injection, moxifloxacin, 100 mg 100 MG 8.734 - - - - - -
J2281 - Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg 100 MG 7.217 - - - - - -
J2300 - Injection, nalbuphine hydrochloride, per 10 mg 10 MG 3.614 - - - - - -
J2305 - Injection, nitroglycerin, 5 mg 5 MG 1.408 - - - - - -
J2310 - Injection, naloxone hydrochloride, per 1 mg 1 MG 8.731 - - - - - -
J2311 - Injection, naloxone hydrochloride (zimhi), 1 mg 1 MG 1.495 - - - - - -
J2315 - Injection, naltrexone, depot form, 1 mg 1 MG 4.116 - - - - - -
J2323 - Injection, natalizumab, 1 mg 1 MG 24.154 - - - - - -
* Effective October 1, 2024 - December 31, 2024

Drugs not otherwise classified - October 2024

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective October 1, 2024 - December 31, 2024

Drug name Dosage Payment limit Notes
Aminocaproic acid 250 MG 0.319
Benzylpenicillin Benzathine (Extencilline) 100,000 UNITS 16.783
Diltiazem Hydrochloride 5 MG 0.378
Doxycycline Hyclate 100 MG 12.923
Famotidine 10 MG 0.324
Flumazenil 0.1 MG 1.183
Folic Acid 5 MG 3.17
Furosemide (Phlow Corporation) 20 MG 1.579
Glucarpidase 10 UNITS 399.73
Metoprolol Tartrate 1 MG 0.129
Rifampin 600 MG 91.656
Sodium Chloride, Hypertonic (3% - 5% infusion) 250 CC 1.393
Sulfamethoxazole-Trimethoprim 400-80 MG 0.629

ASP (Average Sale Price) Drug Pricing History