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 21 * 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
J7193 - Factor ix (antihemophilic factor, purified, non-recombinant) per i.u. 1 IU 1.397 - - - - - - 1
J7194 - Factor ix, complex, per i.u. 1 IU 1.697 - - - - - - 1
J7195 - Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified 1 IU 1.849 - - - - - - 1
J7197 - Antithrombin iii (human), per i.u. 1 IU 4.104 - - - - - -
J7198 - Anti-inhibitor, per i.u. 1 IU 2.413 - - - - - - 1
J7200 - Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu 1 IU 1.69 - - - - - - 1
J7201 - Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u. 1 IU 3.594 - - - - - - 1
J7202 - Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. 1 IU 5.32 - - - - - - 1
J7203 - Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu 1 IU 4.462 - - - - - - 1
J7204 - Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu 1 IU 2.223 - - - - - - 1
J7205 - Injection, factor viii fc fusion protein (recombinant), per iu 1 IU 2.426 - - - - - - 1
J7207 - Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. 1 IU 2.097 - - - - - - 1
J7208 - Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. 1 IU 2.646 - - - - - - 1
J7209 - Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. 1 IU 1.117 - - - - - - 1
J7210 - Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. 1 IU 1.572 - - - - - - 1
J7211 - Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. 1 IU 1.566 - - - - - - 1
J7212 - Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram 1 MCG 2.37 - - - - - - 1
J7213 - Injection, coagulation factor ix (recombinant), ixinity, 1 i.u. 1 IU 1.913 - - - - - - 1
J7214 - Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u. 1 IU 4.663 - - - - - - 1
J7308 - Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) 354 MG 392.09 - - - - - -
J7311 - Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg 0.01 MG 340.313 - - - - - -
J7312 - Injection, dexamethasone, intravitreal implant, 0.1 mg 0.1 MG 204.611 - - - - - -
J7313 - Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg 0.01 MG 498.135 - - - - - -
J7314 - Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg 0.01 MG 529.889 - - - - - -
J7318 - Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg 1 MG 6.773 - - - - - -
* 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