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 15 * 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
J2359 - Injection, olanzapine, 0.5 mg 0.5 MG 0.872 - - - - - -
J2360 - Injection, orphenadrine citrate, up to 60 mg 60 MG 11.186 - - - - - -
J2371 - Injection, phenylephrine hydrochloride, 20 micrograms 20 MCG 0.002 - - - - - -
J2372 - Injection, phenylephrine hydrochloride (biorphen), 20 micrograms 20 MCG 0.166 - - - - - -
J2373 - Injection, phenylephrine hydrochloride (immphentiv), 20 micrograms 20 MCG 0.141 - - - - - -
J2401 - Injection, chloroprocaine hydrochloride, per 1 mg 1 MG 0.04 - - - - - -
J2403 - Chloroprocaine hcl ophthalmic, 3% gel, 1 mg 1 MG 0.583 - - - - - -
J2404 - Injection, nicardipine, 0.1 mg 0.1 MG 0.073 - - - - - -
J2405 - Injection, ondansetron hydrochloride, per 1 mg 1 MG 0.091 - - - - - -
J2406 - Injection, oritavancin (kimyrsa), 10 mg 10 MG 42.478 - - - - - -
J2407 - Injection, oritavancin (orbactiv), 10 mg 10 MG 28.68 - - - - - -
J2425 - Injection, palifermin, 50 micrograms 50 MCG 35.553 - - - - - -
J2426 - Injection, paliperidone palmitate extended release (invega sustenna), 1 mg 1 MG 15.111 - - - - - -
J2427 - Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg 1MG 12.996 - - - - - -
J2428 - Injection, paliperidone palmitate extended release (erzofri), 1 mg 1 MG 16.764 - - - - - -
J2430 - Injection, pamidronate disodium, per 30 mg 30 MG 9.643 - - - - - -
J2468 - Injection, palonosetron hydrochloride (posfrea), 25 micrograms 25 MCG 58.236 - - - - - -
J2469 - Injection, palonosetron hcl, 25 mcg 25 MCG 0.356 - - - - - -
J2501 - Injection, paricalcitol, 1 mcg 1 MCG 0.947 - - - - - -
J2502 - Injection, pasireotide long acting, 1 mg 1 MG 572.96 - - - - - -
J2506 - Injection, pegfilgrastim, excludes biosimilar, 0.5 mg 0.5 MG 89.344 - - - - - -
J2507 - Injection, pegloticase, 1 mg 1 MG 3660.834 - - - - - -
J2508 - Injection, pegunigalsidase alfa-iwxj, 1 mg 1 MG 228.155 - - - - - -
J2540 - Injection, penicillin g potassium, up to 600,000 units 600000 UNITS 0.794 - - - - - -
J2543 - Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) 1.125 GM 1.071 - - - - - -
* 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