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 28 * 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
J9248 - Injection, melphalan (hepzato), 1 mg 1 MG 795 - - - - - -
J9260 - Injection, methotrexate sodium, 50 mg 50 MG 2.816 - - - - - -
J9261 - Injection, nelarabine, 50 mg 50 MG 79.862 - - - - - -
J9263 - Injection, oxaliplatin, 0.5 mg 0.5 MG 0.083 - - - - - -
J9264 - Injection, paclitaxel protein-bound particles, 1 mg 1 MG 10.543 - - - - - -
J9266 - Injection, pegaspargase, per single dose vial 1 EA 28424.059 - - - - - -
J9267 - Injection, paclitaxel, 1 mg 1 MG 0.135 - - - - - -
J9268 - Injection, pentostatin, 10 mg 10 MG 2608.157 - - - - - -
J9269 - Injection, tagraxofusp-erzs, 10 micrograms 10 MCG 356.93 - - - - - -
J9271 - Injection, pembrolizumab, 1 mg 1 MG 60.291 - - - - - -
J9272 - Injection, dostarlimab-gxly, 10 mg 10 MG 243.712 - - - - - -
J9273 - Injection, tisotumab vedotin-tftv, 1 mg 1 MG 188.76 - - - - - -
J9274 - Injection, tebentafusp-tebn, 1 microgram 1 MCG 217.088 - - - - - -
J9276 - Injection, zanidatamab-hrii, 2 mg 2 MG 25.046 - - - - - -
J9280 - Injection, mitomycin, 5 mg 5 MG 20.348 - - - - - -
J9281 - Mitomycin pyelocalyceal instillation, 1 mg 1 MG 318.531 - - - - - -
J9286 - Injection, glofitamab-gxbm, 2.5 mg 2.5 MG 2767.882 - - - - - -
J9289 - Injection, nivolumab, 2 mg and hyaluronidase-nvhy 2 MG 27.362 - - - - - -
J9292 - Injection, pemetrexed dipotassium, 10 mg 10 MG 82.342 - - - - - -
J9293 - Injection, mitoxantrone hydrochloride, per 5 mg 5 MG 23.877 - - - - - -
J9294 - Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg 10 MG 3.547 - - - - - -
J9295 - Injection, necitumumab, 1 mg 1 MG 5.731 - - - - - -
J9296 - Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg 10 mg 9.736 - - - - - -
J9297 - Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg 10 MG 1.754 - - - - - -
J9298 - Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg 3 mg/1 mg 197.832 - - - - - -
* 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