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 13 * 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
J1951 - Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg 0.25 MG 140.99 - - - - - -
J1952 - Leuprolide injectable, camcevi, 1 mg 1 mg 78.916 - - - - - -
J1953 - Injection, levetiracetam, 10 mg 10 MG 0.04 - - - - - -
J1954 - Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg 7.5 MG 706.667 - - - - - -
J1955 - Injection, levocarnitine, per 1 gm 1 GM 23.607 - - - - - -
J1956 - Injection, levofloxacin, 250 mg 250 MG 2.538 - - - - - -
J1961 - Injection, lenacapavir (only for use as hiv treatment), 1 mg 1 MG 22.153 - - - - - -
J2002 - Injection, lidocaine hcl in 5% dextrose, 1 mg 1 MG 0.003 - - - - - -
J2010 - Injection, lincomycin hcl, up to 300 mg 300 MG 4.498 - - - - - -
J2020 - Injection, linezolid, 200 mg 200 MG 3.571 - - - - - -
J2021 - Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg 200 MG 6.338 - - - - - -
J2060 - Injection, lorazepam, 2 mg 2 MG 1.377 - - - - - -
J2151 - Injection, mannitol, 250 mg 250 MG 0.061 - - - - - -
J2175 - Injection, meperidine hydrochloride, per 100 mg 100 MG 15.694 - - - - - -
J2182 - Injection, mepolizumab, 1 mg 1 MG 31.27 - - - - - -
J2183 - Injection, meropenem (wg critical care), not therapeutically equivalent to j2185, 100 mg 100 MG 1.62 - - - - - -
J2184 - Injection, meropenem (b. braun), not therapeutically equivalent to j2185, 100 mg 100 MG 2.07 - - - - - -
J2185 - Injection, meropenem, 100 mg 100 MG 0.421 - - - - - -
J2210 - Injection, methylergonovine maleate, up to 0.2 mg 0.2 MG 20.716 - - - - - -
J2246 - Injection, micafungin in sodium (baxter), not therapeutically equivalent to j2248, 1 mg 1 MG 0.489 - - - - - -
J2247 - Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg 1 MG 0.371 - - - - - -
J2248 - Injection, micafungin sodium, 1 mg 1 MG 0.256 - - - - - -
J2250 - Injection, midazolam hydrochloride, per 1 mg 1 MG 0.154 - - - - - -
J2251 - Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg 1 MG 0.204 - - - - - -
J2260 - Injection, milrinone lactate, 5 mg 5 MG 1.454 - - - - - -
* 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