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 20 * 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
J7040 - Infusion, normal saline solution, sterile (500 ml = 1 unit) 500 ML 1.26 - - - - - -
J7042 - 5% dextrose/normal saline (500 ml = 1 unit) 500 ML 1.414 - - - - - -
J7050 - Infusion, normal saline solution, 250 cc 250 CC 0.649 - - - - - -
J7060 - 5% dextrose/water (500 ml = 1 unit) 500 ML 1.808 - - - - - -
J7070 - Infusion, d5w, 1000 cc 1000 CC 3.113 - - - - - -
J7120 - Ringers lactate infusion, up to 1000 cc 1000 CC 2.409 - - - - - -
J7170 - Injection, emicizumab-kxwh, 0.5 mg 0.5 MG 56.101 - - - - - - 1
J7171 - Injection, adamts13, recombinant-krhn, 10 iu 10 UNITS 35.587 - - - - - -
J7172 - Injection, marstacimab-hncq, 0.5 mg 0.5 MG 51.097 - - - - - - 1
J7173 - Injection, concizumab-mtci, 0.5 mg 0.5 MG 86.405 - - - - - - 1
J7175 - Injection, factor x, (human), 1 i.u. 1 IU 9.775 - - - - - - 1
J7177 - Injection, human fibrinogen concentrate (fibryga), 1 mg 1 MG 1.225 - - - - - - 1
J7178 - Injection, human fibrinogen concentrate, not otherwise specified, 1 mg 1 MG 1.519 - - - - - - 1
J7179 - Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco 1 IU 1.852 - - - - - - 1
J7180 - Injection, factor xiii (antihemophilic factor, human), 1 i.u. 1 IU 10.756 - - - - - - 1
J7181 - Injection, factor xiii a-subunit, (recombinant), per iu 1 IU 18.156 - - - - - - 1
J7182 - Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu 1 IU 1.539 - - - - - - 1
J7183 - Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco 1 I.U. VWF:RCO 1.287 - - - - - - 1
J7185 - Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. 1 IU 1.673 - - - - - - 1
J7186 - Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. PER FACTOR VIII IU 1.245 - - - - - - 1
J7187 - Injection, von willebrand factor complex (humate-p), per iu vwf:rco 1 IU 1.491 - - - - - - 1
J7188 - Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. 1 IU 3.227 - - - - - - 1
J7189 - Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram 1 MCG 2.655 - - - - - - 1
J7190 - Factor viii (antihemophilic factor, human) per i.u. 1 IU 1.085 - - - - - - 1
J7192 - Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified 1 IU 1.613 - - - - - - 1
* 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