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 30 * 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
J9333 - Injection, rozanolixizumab-noli, 1 mg 1 MG 23.165 - - - - - -
J9334 - Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc 2 MG 33.888 - - - - - -
J9342 - Injection, thiotepa, not otherwise specified, 1 mg 1 MG 10.537 - - - - - -
J9345 - Injection, retifanlimab-dlwr, 1 mg 1 MG 30.556 - - - - - -
J9347 - Injection, tremelimumab-actl, 1 mg 1 MG 140.897 - - - - - -
J9348 - Injection, naxitamab-gqgk, 1 mg 1 MG 686.002 - - - - - -
J9349 - Injection, tafasitamab-cxix, 2 mg 2 MG 14.311 - - - - - -
J9350 - Injection, mosunetuzumab-axgb, 1 mg 1 MG 654.629 - - - - - -
J9351 - Injection, topotecan, 0.1 mg 0.1 MG 2.541 - - - - - -
J9352 - Injection, trabectedin, 0.1 mg 0.1 MG 391.07 - - - - - -
J9353 - Injection, margetuximab-cmkb, 5 mg 5 MG 52.486 - - - - - -
J9354 - Injection, ado-trastuzumab emtansine, 1 mg 1 MG 42.16 - - - - - -
J9355 - Injection, trastuzumab, excludes biosimilar, 10 mg 10 MG 75.025 - - - - - -
J9356 - Injection, trastuzumab, 10 mg and hyaluronidase-oysk 10 MG 61.436 - - - - - -
J9357 - Injection, valrubicin, intravesical, 200 mg 200 MG 1323.345 - - - - - -
J9358 - Injection, fam-trastuzumab deruxtecan-nxki, 1 mg 1 MG 29.978 - - - - - -
J9359 - Injection, loncastuximab tesirine-lpyl, 0.075 mg 0.075 MG 216.903 - - - - - -
J9360 - Injection, vinblastine sulfate, 1 mg 1 MG 5.3 - - - - - -
J9370 - Vincristine sulfate, 1 mg 1 MG 8.222 - - - - - -
J9380 - Injection, teclistamab-cqyv, 0.5 mg 0.5 MG 33.575 - - - - - -
J9381 - Injection, teplizumab-mzwv, 5 mcg 5 MCG 37.662 - - - - - -
J9382 - Injection, zenocutuzumab-zbco, 1 mg 1 MG 32.91 - - - - - -
J9390 - Injection, vinorelbine tartrate, 10 mg 10 MG 7.682 - - - - - -
J9394 - Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg 25 MG 26.769 - - - - - -
J9395 - Injection, fulvestrant, 25 mg 25 MG 6.728 - - - - - -
* 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