ASP Drug Pricing - (4th Quarter)
October 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Apr 2025 (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 10 * Effective October 1, 2025 - December 31, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J1454 - Injection, fosnetupitant 235 mg and palonosetron 0.25 mg 0.25 MG 575.503 - - - - - -
J1455 - Injection, foscarnet sodium, per 1000 mg 1000 MG 16.077 - - - - - -
J1456 - Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg 1 MG 1.03 - - - - - -
J1458 - Injection, galsulfase, 1 mg 1 MG 508.758 - - - - - -
J1459 - Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 50.737 - - - - - -
J1460 - Injection, gamma globulin, intramuscular, 1 cc 1 CC 49.033 - - - - - -
J1551 - Injection, immune globulin (cutaquig), 100 mg 100 MG 14.232 - - - - - -
J1552 - Injection, immune globulin (alyglo), 500 mg 500 MG 130.236 - - - - - -
J1554 - Injection, immune globulin (asceniv), 500 mg 500 MG 496.739 - - - - - -
J1555 - Injection, immune globulin (cuvitru), 100 mg 100 MG 16.842 - - - - - -
J1556 - Injection, immune globulin (bivigam), 500 mg 500 MG 77.39 - - - - - -
J1557 - Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 63.683 - - - - - -
J1558 - Injection, immune globulin (xembify), 100 mg 100 MG 14.845 - - - - - -
J1559 - Injection, immune globulin (hizentra), 100 mg 100 MG 14.337 - - - - - -
J1560 - Injection, gamma globulin, intramuscular, over 10 cc 10 CC 170.476 - - - - - -
J1561 - Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg 500 MG 48.964 - - - - - -
J1566 - Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg 500 MG 78.795 - - - - - -
J1568 - Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 47.525 - - - - - -
J1569 - Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg 500 MG 45.314 - - - - - -
J1570 - Injection, ganciclovir sodium, 500 mg 500 MG 39.543 - - - - - -
J1571 - Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml 0.5 ML 66.641 - - - - - -
J1573 - Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml 0.5 ML 66.641 - - - - - -
J1575 - Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin 100 MG 18.151 - - - - - -
J1576 - Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg 500 MG 72.996 - - - - - -
J1580 - Injection, garamycin, gentamicin, up to 80 mg 80 MG 2.208 - - - - - -
* Effective October 1, 2025 - December 31, 2025

Drugs not otherwise classified - October 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective October 1, 2025 - December 31, 2025

Drug name Dosage Payment limit Notes
Vasopressin (Long Grove) 1 UNIT 2.462

ASP (Average Sale Price) Drug Pricing History