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 22 * 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
J7320 - Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg 1 MG 5.773 - - - - - -
J7321 - Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose per dose 71.523 - - - - - -
J7322 - Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg 1 MG 17.618 - - - - - -
J7323 - Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose per dose 112.454 - - - - - -
J7324 - Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose PER DOSE 114.536 - - - - - -
J7325 - Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg 1 MG 7.951 - - - - - -
J7326 - Hyaluronan or derivative, gel-one, for intra-articular injection, per dose per dose 529.258 - - - - - -
J7327 - Hyaluronan or derivative, monovisc, for intra-articular injection, per dose PER DOSE 636.59 - - - - - -
J7328 - Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg 0.1 MG 0.696 - - - - - -
J7329 - Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg 1 MG 4.691 - - - - - -
J7331 - Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg 1 MG 3.633 - - - - - -
J7332 - Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg 1 MG 10.269 - - - - - -
J7336 - Capsaicin 8% patch, per square centimeter 1 SQ CM 3.421 - - - - - -
J7340 - Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml 100 ML 243.607 - - - - - -
J7345 - Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg 10 MG 1.793 - - - - - -
J7351 - Injection, bimatoprost, intracameral implant, 1 microgram 1 MCG 213.841 - - - - - -
J7354 - Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) Per 3.2 mg single-use applicator 654.757 - - - - - -
J7355 - Injection, travoprost, intracameral implant, 1 microgram 1 MCG 195.721 - - - - - -
J7356 - Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg 0.25 MG - 5 MG 0.706 - - - - - -
J7402 - Mometasone furoate sinus implant, (sinuva), 10 micrograms 10 MCG 11.345 - - - - - -
J7500 - Azathioprine, oral, 50 mg 50 MG 0.062 - - - - - -
J7502 - Cyclosporine, oral, 100 mg 100 MG 2.039 - - - - - -
J7503 - Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg 0.25 MG 1.831 - - - - - -
J7504 - Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg 250 MG 5135.09 - - - - - -
J7507 - Tacrolimus, immediate release, oral, 1 mg 1 MG 0.169 - - - - - -
* 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