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 38 * 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
Q5100 - Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg 1 MG 24.979 - - - - - -
Q5101 - Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram 1 MCG 0.458 - - - - - -
Q5103 - Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg 10 MG 19.99 - - - - - -
Q5104 - Injection, infliximab-abda, biosimilar, (renflexis), 10 mg 10 MG 26.999 - - - - - -
Q5105 - Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units 100 UNITS 0.785 - - - - - -
Q5106 - Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units 1000 UNITS 7.851 - - - - - -
Q5107 - Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg 10 MG 27.862 - - - - - -
Q5108 - Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg 0.5 MG 99.128 - - - - - -
Q5110 - Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram 1 MCG 0.304 - - - - - -
Q5111 - Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg 0.5 MG 106.334 - - - - - -
Q5112 - Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg 10 MG 19.001 - - - - - -
Q5113 - Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg 10 MG 69.368 - - - - - -
Q5114 - Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg 10 MG 40.294 - - - - - -
Q5115 - Injection, rituximab-abbs, biosimilar, (truxima), 10 mg 10 MG 29.379 - - - - - -
Q5116 - Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg 10 MG 27.991 - - - - - -
Q5117 - Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg 10 MG 47.547 - - - - - -
Q5118 - Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg 10 MG 25.766 - - - - - -
Q5119 - Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg 10 MG 27.845 - - - - - -
Q5120 - Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg 0.5 MG 30.323 - - - - - -
Q5121 - Injection, infliximab-axxq, biosimilar, (avsola), 10 mg 10 MG 20.405 - - - - - -
Q5122 - Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg 0.5 MG 131.158 - - - - - -
Q5123 - Injection, rituximab-arrx, biosimilar, (riabni), 10 mg 10 MG 26.509 - - - - - -
Q5124 - Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg 0.1 MG 61.796 - - - - - -
Q5125 - Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram 1 MCG 0.375 - - - - - -
Q5126 - Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg 10 MG 37.818 - - - - - -
* 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