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 18 * 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
J3095 - Injection, telavancin, 10 mg 10 MG 7.113 - - - - - -
J3101 - Injection, tenecteplase, 1 mg 1 MG 172.221 - - - - - -
J3105 - Injection, terbutaline sulfate, up to 1 mg 1 MG 7.391 - - - - - -
J3111 - Injection, romosozumab-aqqg, 1 mg 1 MG 12.07 - - - - - -
J3121 - Injection, testosterone enanthate, 1 mg 1 MG 0.052 - - - - - -
J3145 - Injection, testosterone undecanoate, 1 mg 1 MG 2.069 - - - - - -
J3230 - Injection, chlorpromazine hcl, up to 50 mg 50 MG 25.268 - - - - - -
J3240 - Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial 0.9 MG 2116.323 - - - - - -
J3241 - Injection, teprotumumab-trbw, 10 mg 10 MG 359.192 - - - - - -
J3243 - Injection, tigecycline, 1 mg 1 MG 0.385 - - - - - -
J3245 - Injection, tildrakizumab, 1 mg 1 MG 127.453 - - - - - -
J3246 - Injection, tirofiban hcl, 0.25 mg 0.25 MG 3.478 - - - - - -
J3247 - Injection, secukinumab, intravenous, 1 mg 1 MG 17.843 - - - - - -
J3250 - Injection, trimethobenzamide hcl, up to 200 mg 200 MG 57.506 - - - - - -
J3260 - Injection, tobramycin sulfate, up to 80 mg 80 MG 2.373 - - - - - -
J3262 - Injection, tocilizumab, 1 mg 1 MG 5.708 - - - - - -
J3263 - Injection, toripalimab-tpzi, 1 mg 1 MG 39.409 - - - - - -
J3285 - Injection, treprostinil, 1 mg 1 MG 54.707 - - - - - -
J3299 - Injection, triamcinolone acetonide (xipere), 1 mg 1 MG 47.973 - - - - - -
J3300 - Injection, triamcinolone acetonide, preservative free, 1 mg 1 MG 24.498 - - - - - -
J3301 - Injection, triamcinolone acetonide, not otherwise specified, 10 mg 10 MG 0.844 - - - - - -
J3304 - Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg 1 MG 18.297 - - - - - -
J3315 - Injection, triptorelin pamoate, 3.75 mg 3.75 MG 474.838 - - - - - -
J3316 - Injection, triptorelin, extended-release, 3.75 mg 3.75 MG 3817.277 - - - - - -
J3358 - Ustekinumab, for intravenous injection, 1 mg 1 MG 12.993 - - - - - -
* 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