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 14 * 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
J2267 - Injection, mirikizumab-mrkz, 1 mg 1 MG 43.048 - - - - - -
J2270 - Injection, morphine sulfate, up to 10 mg 10 MG 2.182 - - - - - -
J2272 - Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg 10 MG 8.747 - - - - - -
J2274 - Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg 10 MG 12.055 - - - - - -
J2277 - Injection, motixafortide, 0.25 mg 0.25 MG 25.218 - - - - - -
J2278 - Injection, ziconotide, 1 microgram 1 MCG 10.14 - - - - - -
J2280 - Injection, moxifloxacin, 100 mg 100 MG 9.015 - - - - - -
J2281 - Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg 100 MG 7.412 - - - - - -
J2290 - Injection, nafcillin sodium, 20 mg 20 MG 0.054 - - - - - -
J2291 - Injection, nafcillin sodium (baxter), 20 mg 20 MG 0.15 - - - - - -
J2300 - Injection, nalbuphine hydrochloride, per 10 mg 10 MG 3.704 - - - - - -
J2305 - Injection, nitroglycerin, 5 mg 5 MG 1.487 - - - - - -
J2312 - Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg 0.01 MG 0.075 - - - - - -
J2313 - Injection, naloxone hydrochloride (zimhi), 0.01 mg 0.01 MG 0.015 - - - - - -
J2315 - Injection, naltrexone, depot form, 1 mg 1 MG 4.24 - - - - - -
J2323 - Injection, natalizumab, 1 mg 1 MG 23.996 - - - - - -
J2327 - Injection, risankizumab-rzaa, intravenous, 1 mg 1 MG 14.941 - - - - - -
J2329 - Injection, ublituximab-xiiy, 1mg 1 MG 70.753 - - - - - -
J2350 - Injection, ocrelizumab, 1 mg 1 MG 59.414 - - - - - -
J2351 - Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq 1 MG 47.233 - - - - - -
J2353 - Injection, octreotide, depot form for intramuscular injection, 1 mg 1 MG 203.583 - - - - - -
J2354 - Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg 25 MCG 0.61 - - - - - -
J2356 - Injection, tezepelumab-ekko, 1 mg 1 MG 18.009 - - - - - -
J2357 - Injection, omalizumab, 5 mg 5 MG 44.596 - - - - - -
J2358 - Injection, olanzapine, long-acting, 1 mg 1 MG 2.917 - - - - - -
* 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