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 26 * 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
J9061 - Injection, amivantamab-vmjw, 2 mg 2 MG 22.54 - - - - - -
J9063 - Injection, mirvetuximab soravtansine-gynx, 1 mg 1 MG 69.486 - - - - - -
J9065 - Injection, cladribine, per 1 mg 1 MG 10.678 - - - - - -
J9071 - Injection, cyclophosphamide (auromedics), 5 mg 5 MG 0.63 - - - - - -
J9072 - Injection, cyclophosphamide (frindovyx), 5 mg 5 MG 9.105 - - - - - -
J9073 - Injection, cyclophosphamide (dr. reddy's), 5 mg 5 MG 0.784 - - - - - -
J9074 - Injection, cyclophosphamide (sandoz), 5 mg 5 MG 3.936 - - - - - -
J9075 - Injection, cyclophosphamide, not otherwise specified, 5 mg 5 MG 0.481 - - - - - -
J9076 - Injection, cyclophosphamide (baxter), 5 mg 5 MG 5.014 - - - - - -
J9100 - Injection, cytarabine, 100 mg 100 MG 0.83 - - - - - -
J9118 - Injection, calaspargase pegol-mknl, 10 units 10 UNIT 82.075 - - - - - -
J9119 - Injection, cemiplimab-rwlc, 1 mg 1 MG 29.293 - - - - - -
J9120 - Injection, dactinomycin, 0.5 mg 0.5 MG 328.338 - - - - - -
J9130 - Dacarbazine, 100 mg 100 MG 3.447 - - - - - -
J9144 - Injection, daratumumab, 10 mg and hyaluronidase-fihj 10 MG 55.567 - - - - - -
J9145 - Injection, daratumumab, 10 mg 10 MG 71.371 - - - - - -
J9150 - Injection, daunorubicin, 10 mg 10 MG 21.699 - - - - - -
J9153 - Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine 1 MG/2.27 MG 256.087 - - - - - -
J9155 - Injection, degarelix, 1 mg 1 MG 4.448 - - - - - -
J9171 - Injection, docetaxel, 1 mg 1 MG 0.626 - - - - - -
J9172 - Injection, docetaxel (docivyx), 1 mg 1 MG 50.778 - - - - - -
J9173 - Injection, durvalumab, 10 mg 10 MG 85.12 - - - - - -
J9176 - Injection, elotuzumab, 1 mg 1 MG 7.885 - - - - - -
J9177 - Injection, enfortumab vedotin-ejfv, 0.25 mg 0.25 MG 36.743 - - - - - -
J9178 - Injection, epirubicin hcl, 2 mg 2 MG 2.112 - - - - - -
* 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