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 25 * 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
J9025 - Injection, azacitidine, 1 mg 1 MG 0.566 - - - - - -
J9026 - Injection, tarlatamab-dlle, 1 mg 1 MG 1564.636 - - - - - -
J9027 - Injection, clofarabine, 1 mg 1 MG 4.19 - - - - - -
J9028 - Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram 1 MCG 94.662 - - - - - -
J9029 - Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose PER THERAPEUTIC DOSE 63342.282 - - - - - -
J9030 - Bcg live intravesical instillation, 1 mg 1 MG 3.26 - - - - - -
J9032 - Injection, belinostat, 10 mg 10 MG 52.474 - - - - - -
J9033 - Injection, bendamustine hydrochloride, 1 mg 1 MG 1.883 - - - - - -
J9034 - Injection, bendamustine hcl (bendeka), 1 mg 1 MG 13.488 - - - - - -
J9035 - Injection, bevacizumab, 10 mg 10 MG 73.201 - - - - - -
J9036 - Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg 1 MG 12.284 - - - - - -
J9038 - Injection, axatilimab-csfr, 0.1 mg 0.1 MG 55.65 - - - - - -
J9039 - Injection, blinatumomab, 1 microgram 1 MCG 164.253 - - - - - -
J9040 - Injection, bleomycin sulfate, 15 units 15 UNITS 21.525 - - - - - -
J9041 - Injection, bortezomib, 0.1 mg 0.1 MG 2.791 - - - - - -
J9042 - Injection, brentuximab vedotin, 1 mg 1 MG 258.64 - - - - - -
J9043 - Injection, cabazitaxel, 1 mg 1 MG 227.277 - - - - - -
J9045 - Injection, carboplatin, 50 mg 50 MG 2.471 - - - - - -
J9047 - Injection, carfilzomib, 1 mg 1 MG 55.647 - - - - - -
J9049 - Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg 0.1 MG 1.466 - - - - - -
J9050 - Injection, carmustine, 100 mg 100 MG 238.456 - - - - - -
J9054 - Injection, bortezomib (boruzu), 0.1 mg 0.1 MG 26.15 - - - - - -
J9055 - Injection, cetuximab, 10 mg 10 MG 78.369 - - - - - -
J9056 - Injection, bendamustine hydrochloride (vivimusta), 1 mg 1 MG 29.852 - - - - - -
J9060 - Injection, cisplatin, powder or solution, 10 mg 10 MG 2.294 - - - - - -
* 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