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 27 * 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
J9179 - Injection, eribulin mesylate, 0.1 mg 0.1 MG 89.344 - - - - - -
J9181 - Injection, etoposide, 10 mg 10 MG 0.941 - - - - - -
J9185 - Injection, fludarabine phosphate, 50 mg 50 MG 68.197 - - - - - -
J9190 - Injection, fluorouracil, 500 mg 500 MG 1.99 - - - - - -
J9196 - Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg 200 MG 5.29 - - - - - -
J9200 - Injection, floxuridine, 500 mg 500 MG 4128.019 - - - - - -
J9201 - Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg 200 MG 3.128 - - - - - -
J9202 - Goserelin acetate implant, per 3.6 mg 3.6 MG 733.665 - - - - - -
J9203 - Injection, gemtuzumab ozogamicin, 0.1 mg 0.1 MG 236.616 - - - - - -
J9204 - Injection, mogamulizumab-kpkc, 1 mg 1 MG 248.497 - - - - - -
J9205 - Injection, irinotecan liposome, 1 mg 1 MG 65.999 - - - - - -
J9206 - Injection, irinotecan, 20 mg 20 MG 1.751 - - - - - -
J9207 - Injection, ixabepilone, 1 mg 1 MG 139.212 - - - - - -
J9208 - Injection, ifosfamide, 1 gram 1 GM 25.204 - - - - - -
J9209 - Injection, mesna, 200 mg 200 MG 1.859 - - - - - -
J9210 - Injection, emapalumab-lzsg, 1 mg 1 MG 384.848 - - - - - -
J9211 - Injection, idarubicin hydrochloride, 5 mg 5 MG 36.67 - - - - - -
J9217 - Leuprolide acetate (for depot suspension), 7.5 mg 7.5 MG 176.447 - - - - - -
J9223 - Injection, lurbinectedin, 0.1 mg 0.1 MG 207.127 - - - - - -
J9226 - Histrelin implant (supprelin la), 50 mg 50 MG 45020.65 - - - - - -
J9227 - Injection, isatuximab-irfc, 10 mg 10 MG 81.9 - - - - - -
J9228 - Injection, ipilimumab, 1 mg 1 MG 183.479 - - - - - -
J9229 - Injection, inotuzumab ozogamicin, 0.1 mg 0.1 MG 2698.053 - - - - - -
J9245 - Injection, melphalan hydrochloride, not otherwise specified, 50 mg 50 MG 95.901 - - - - - -
J9246 - Injection, melphalan (evomela), 1 mg 1 MG 18.497 - - - - - -
* 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