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 15 * 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
J2783 - Injection, rasburicase, 0.5 mg 0.5 MG 371.293 - - - - - -
J2785 - Injection, regadenoson, 0.1 mg 0.1 MG 2.88 - - - - - -
J2786 - Injection, reslizumab, 1 mg 1 MG 10.311 - - - - - -
J2788 - Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) 50 MCG (250 IU) 24.038 - - - - - -
J2790 - Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) 300 MCG (1500 IU) 80.139 - - - - - -
J2791 - Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu 100 IU 4.798 - - - - - -
J2792 - Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu 100 IU 34.336 - - - - - -
J2794 - Injection, risperidone (risperdal consta), 0.5 mg 0.5 MG 11.299 - - - - - -
J2795 - Injection, ropivacaine hydrochloride, 1 mg 1 MG 0.062 - - - - - -
J2796 - Injection, romiplostim, 10 micrograms 10 MCG 101.052 - - - - - -
J2798 - Injection, risperidone, (perseris), 0.5 mg 0.5 mg 12.19 - - - - - -
J2799 - Injection, risperidone (uzedy), 1 mg 1 MG 24.766 - - - - - -
J2800 - Injection, methocarbamol, up to 10 ml 10 ML 7.253 - - - - - -
J2805 - Injection, sincalide, 5 micrograms 5 MCG 123.618 - - - - - -
J2820 - Injection, sargramostim (gm-csf), 50 mcg 50 MCG 60.275 - - - - - -
J2860 - Injection, siltuximab, 10 mg 10 MG 157.072 - - - - - -
J2916 - Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg 12.5 MG 2.19 - - - - - -
J2919 - Injection, methylprednisolone sodium succinate, 5 mg 5 MG 0.304 - - - - - -
J2997 - Injection, alteplase recombinant, 1 mg 1 MG 91.47 - - - - - -
J3000 - Injection, streptomycin, up to 1 gm 1 GM 32.745 - - - - - -
J3010 - Injection, fentanyl citrate, 0.1 mg 0.1 MG 0.903 - - - - - -
J3032 - Injection, eptinezumab-jjmr, 1 mg 1 MG 18.693 - - - - - -
J3055 - Injection, talquetamab-tgvs, 0.25 mg 0.25 MG 67.652 - - - - - -
J3060 - Injection, taliglucerase alfa, 10 units 10 UNITS 42.581 - - - - - -
J3090 - Injection, tedizolid phosphate, 1 mg 1 MG 1.809 - - - - - -
* 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