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 17 * 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
J2786 - Injection, reslizumab, 1 mg 1 MG 10.951 - - - - - -
J2788 - Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) 50 MCG (250 IU) 25.591 - - - - - -
J2790 - Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) 300 MCG (1500 IU) 82.575 - - - - - -
J2791 - Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu 100 IU 4.855 - - - - - -
J2792 - Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu 100 IU 25.457 - - - - - -
J2794 - Injection, risperidone (risperdal consta), 0.5 mg 0.5 MG 10.978 - - - - - -
J2795 - Injection, ropivacaine hydrochloride, 1 mg 1 MG 0.046 - - - - - -
J2798 - Injection, risperidone, (perseris), 0.5 mg 0.5 mg 12.141 - - - - - -
J2799 - Injection, risperidone (uzedy), 1 mg 1 MG 25.038 - - - - - -
J2800 - Injection, methocarbamol, up to 10 ml 10 ML 4.787 - - - - - -
J2802 - Injection, romiplostim, 1 microgram 1 MCG 11.013 - - - - - -
J2804 - Injection, rifampin, 1 mg 1 MG 0.142 - - - - - -
J2805 - Injection, sincalide, 5 micrograms 5 MCG 123.362 - - - - - -
J2820 - Injection, sargramostim (gm-csf), 50 mcg 50 MCG 50.365 - - - - - -
J2860 - Injection, siltuximab, 10 mg 10 MG 165.831 - - - - - -
J2865 - Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg 5MG-1MG 0.046 - - - - - -
J2916 - Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg 12.5 MG 2.023 - - - - - -
J2919 - Injection, methylprednisolone sodium succinate, 5 mg 5 MG 0.21 - - - - - -
J2997 - Injection, alteplase recombinant, 1 mg 1 MG 94.447 - - - - - -
J3000 - Injection, streptomycin, up to 1 gm 1 GM 36.687 - - - - - -
J3010 - Injection, fentanyl citrate, 0.1 mg 0.1 MG 1.098 - - - - - -
J3032 - Injection, eptinezumab-jjmr, 1 mg 1 MG 19.974 - - - - - -
J3055 - Injection, talquetamab-tgvs, 0.25 mg 0.25 MG 72.618 - - - - - -
J3060 - Injection, taliglucerase alfa, 10 units 10 UNITS 41.11 - - - - - -
J3090 - Injection, tedizolid phosphate, 1 mg 1 MG 1.964 - - - - - -
* 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