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 19 * 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
J3360 - Injection, diazepam, up to 5 mg 5 MG 7.348 - - - - - -
J3373 - Injection, vancomycin hydrochloride, 10 mg 10 MG 0.03 - - - - - -
J3374 - Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg 10 MG 0.115 - - - - - -
J3375 - Injection, vancomycin hydrochloride (xellia), not therapeutically equivalent to j3373, 10 mg 10 MG 0.139 - - - - - -
J3380 - Injection, vedolizumab, intravenous, 1 mg 1 MG 21.311 - - - - - -
J3385 - Injection, velaglucerase alfa, 100 units 100 UNITS 381.36 - - - - - -
J3396 - Injection, verteporfin, 0.1 mg 0.1 MG 11.538 - - - - - -
J3401 - Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml 0.1 ML 1025.436 - - - - - -
J3402 - Injection, remestemcel-l-rknd, per therapeutic dose Per Therapeutic Dose 205640 - - - - - -
J3410 - Injection, hydroxyzine hcl, up to 25 mg 25 MG 15.297 - - - - - -
J3411 - Injection, thiamine hcl, 100 mg 100 MG 1.817 - - - - - -
J3415 - Injection, pyridoxine hcl, 100 mg 100 MG 6.046 - - - - - -
J3420 - Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg 1000 MCG 1.005 - - - - - -
J3425 - Injection, hydroxocobalamin, intramuscular, 10 mcg 10 MCG 0.008 - - - - - -
J3430 - Injection, phytonadione (vitamin k), per 1 mg 1 MG 2.727 - - - - - -
J3465 - Injection, voriconazole, 10 mg 10 MG 0.774 - - - - - -
J3470 - Injection, hyaluronidase, up to 150 units 150 UNITS 32.218 - - - - - -
J3471 - Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) 1 USP UNIT 0.499 - - - - - -
J3473 - Injection, hyaluronidase, recombinant, 1 usp unit 1 USP UNIT 0.362 - - - - - -
J3475 - Injection, magnesium sulfate, per 500 mg 500 MG 0.481 - - - - - -
J3480 - Injection, potassium chloride, per 2 meq 2 MEQ 0.112 - - - - - -
J3485 - Injection, zidovudine, 10 mg 10 MG 1.513 - - - - - -
J3486 - Injection, ziprasidone mesylate, 10 mg 10 MG 6.826 - - - - - -
J3489 - Injection, zoledronic acid, 1 mg 1 MG 5.056 - - - - - -
J7030 - Infusion, normal saline solution , 1000 cc 1000 CC 1.949 - - - - - -
* 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