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 16 * 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
J2545 - Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg 300 MG 69.728 - - - - - -
J2550 - Injection, promethazine hcl, up to 50 mg 50 MG 2.952 - - - - - -
J2560 - Injection, phenobarbital sodium, up to 120 mg 120 MG 30.166 - - - - - -
J2562 - Injection, plerixafor, 1 mg 1 MG 25.331 - - - - - -
J2597 - Injection, desmopressin acetate, per 1 mcg 1 MCG 3.524 - - - - - -
J2598 - Injection, vasopressin, 1 unit 1 UNIT 0.926 - - - - - -
J2599 - Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit 1 UNIT 0.609 - - - - - -
J2601 - Injection, vasopressin (baxter), 1 unit 1 UNIT 2.008 - - - - - -
J2675 - Injection, progesterone, per 50 mg 50 MG 0.702 - - - - - -
J2679 - Injection, fluphenazine hcl, 1.25 mg 1.25 MG 7.336 - - - - - -
J2680 - Injection, fluphenazine decanoate, up to 25 mg 25 MG 7.305 - - - - - -
J2690 - Injection, procainamide hcl, up to 1 gm 1 GM 294.691 - - - - - -
J2700 - Injection, oxacillin sodium, up to 250 mg 250 MG 0.787 - - - - - -
J2704 - Injection, propofol, 10 mg 10 MG 0.09 - - - - - -
J2720 - Injection, protamine sulfate, per 10 mg 10 MG 1.745 - - - - - -
J2724 - Injection, protein c concentrate, intravenous, human, 10 iu 10 UNITS 15.041 - - - - - -
J2760 - Injection, phentolamine mesylate, up to 5 mg 5 MG 432.022 - - - - - -
J2765 - Injection, metoclopramide hcl, up to 10 mg 10 MG 1.085 - - - - - -
J2777 - Injection, faricimab-svoa, 0.1 mg 0.1 MG 33.877 - - - - - -
J2778 - Injection, ranibizumab, 0.1 mg 0.1 mg 86.384 - - - - - -
J2779 - Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg 0.1 MG 78.934 - - - - - -
J2781 - Injection, pegcetacoplan, intravitreal, 1 mg 1 MG 139.181 - - - - - -
J2782 - Injection, avacincaptad pegol, 0.1 mg 0.1 MG 105.124 - - - - - -
J2783 - Injection, rasburicase, 0.5 mg 0.5 MG 377.521 - - - - - -
J2785 - Injection, regadenoson, 0.1 mg 0.1 MG 3.018 - - - - - -
* 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