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 24 * 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
J7639 - Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram 1 MG 55.162 - - - - - -
J7644 - Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram 1 MG 0.39 - - - - - -
J7674 - Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg 1 MG 1.755 - - - - - -
J7677 - Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram 1 MCG 0.188 - - - - - -
J7682 - Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams 300 MG 16.216 - - - - - -
J7686 - Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg 1.74 MG 796.093 - - - - - -
J8501 - Aprepitant, oral, 5 mg 5 MG 2.725 - - - - - -
J8522 - Capecitabine, oral, 50 mg 50 MG 0.037 - - - - - -
J8530 - Cyclophosphamide; oral, 25 mg 25 MG 1.097 - - - - - -
J8540 - Dexamethasone, oral, 0.25 mg 0.25 MG 0.015 - - - - - -
J8560 - Etoposide; oral, 50 mg 50 MG 77.462 - - - - - -
J8610 - Methotrexate; oral, 2.5 mg 2.5 MG 0.189 - - - - - -
J8611 - Methotrexate (jylamvo), oral, 2.5 mg 2.5 MG 18.466 - - - - - -
J8612 - Methotrexate (xatmep), oral, 2.5 mg 2.5 MG 22.68 - - - - - -
J8655 - Netupitant 300 mg and palonosetron 0.5 mg, oral 0.5 MG 422.893 - - - - - -
J8670 - Rolapitant, oral, 1 mg 1 MG 1.855 - - - - - -
J8700 - Temozolomide, oral, 5 mg 5 MG 0.455 - - - - - -
J8705 - Topotecan, oral, 0.25 mg 0.25 mg 124.832 - - - - - -
J9000 - Injection, doxorubicin hydrochloride, 10 mg 10 MG 3.018 - - - - - -
J9011 - Injection, datopotamab deruxtecan-dlnk, 1 mg 1 MG 51.558 - - - - - -
J9017 - Injection, arsenic trioxide, 1 mg 1 MG 8.153 - - - - - -
J9021 - Injection, asparaginase, recombinant, (rylaze), 0.1 mg 0.1 MG 55.473 - - - - - -
J9022 - Injection, atezolizumab, 10 mg 10 MG 91.34 - - - - - -
J9023 - Injection, avelumab, 10 mg 10 MG 100.087 - - - - - -
J9024 - Injection, atezolizumab, 5 mg and hyaluronidase-tqjs 5 MG 31.584 - - - - - -
* 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