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 11 * 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
J1596 - Injection, glycopyrrolate, 0.1 mg 0.1 MG 0.457 - - - - - -
J1598 - Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg 0.1 MG 1.342 - - - - - -
J1602 - Injection, golimumab, 1 mg, for intravenous use 1 MG 11.039 - - - - - -
J1610 - Injection, glucagon hydrochloride, per 1 mg 1 MG 182.447 - - - - - -
J1611 - Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg 1 MG 148.989 - - - - - -
J1626 - Injection, granisetron hydrochloride, 100 mcg 100 MCG 0.185 - - - - - -
J1627 - Injection, granisetron, extended-release, 0.1 mg 0.1 MG 4.288 - - - - - -
J1628 - Injection, guselkumab, 1 mg 1 MG 75.972 - - - - - -
J1630 - Injection, haloperidol, up to 5 mg 5 MG 0.802 - - - - - -
J1631 - Injection, haloperidol decanoate, per 50 mg 50 MG 4.401 - - - - - -
J1640 - Injection, hemin, 1 mg 1 MG 34.181 - - - - - -
J1642 - Injection, heparin sodium, (heparin lock flush), per 10 units 10 UNITS 0.017 - - - - - -
J1643 - Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units 1000 UNITS 3.007 - - - - - -
J1644 - Injection, heparin sodium, per 1000 units 1000 UNITS 0.207 - - - - - -
J1645 - Injection, dalteparin sodium, per 2500 iu 2500 IU 16.541 - - - - - -
J1650 - Injection, enoxaparin sodium, 10 mg 10 MG 0.587 - - - - - -
J1652 - Injection, fondaparinux sodium, 0.5 mg 0.5 MG 0.723 - - - - - -
J1670 - Injection, tetanus immune globulin, human, up to 250 units 250 UNITS 593.003 - - - - - -
J1720 - Injection, hydrocortisone sodium succinate, up to 100 mg 100 MG 21.312 - - - - - -
J1740 - Injection, ibandronate sodium, 1 mg 1 MG 28.613 - - - - - -
J1741 - Injection, ibuprofen, 100 mg 100 MG 3.1 - - - - - -
J1743 - Injection, idursulfase, 1 mg 1 MG 558.456 - - - - - -
J1745 - Injection, infliximab, excludes biosimilar, 10 mg 10 MG 31.09 - - - - - -
J1746 - Injection, ibalizumab-uiyk, 10 mg 10 MG 79.259 - - - - - -
J1747 - Injection, spesolimab-sbzo, 1 mg 1 MG 65.728 - - - - - -
* 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