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 39 * 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
Q5127 - Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg 0.5 MG 184.908 - - - - - -
Q5128 - Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg 0.1 MG 86.156 - - - - - -
Q5129 - Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg 10 MG 39.964 - - - - - -
Q5130 - Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg 0.5 MG 137.965 - - - - - -
Q5133 - Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg 1 MG 5.536 - - - - - -
Q5135 - Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg 1 MG 4.415 - - - - - -
Q5138 - Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg 1 MG 11.645 - - - - - -
Q5146 - Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg 10 MG 40.025 - - - - - -
Q5147 - Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg 1 MG 859.363 - - - - - -
Q9950 - Injection, sulfur hexafluoride lipid microspheres, per ml 1 ML 18.592 - - - - - -
Q9956 - Injection, octafluoropropane microspheres, per ml 1 ML 40.653 - - - - - -
Q9957 - Injection, perflutren lipid microspheres, per ml 1 ML 40.653 - - - - - -
Q9958 - High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml 1 ML 0.075 - - - - - -
Q9961 - High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml 1 ML 0.242 - - - - - -
Q9963 - High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml 1 ML 0.216 - - - - - -
Q9965 - Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml 1 ML 0.959 - - - - - -
Q9966 - Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml 1 ML 0.45 - - - - - -
Q9967 - Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 1 ML 0.152 - - - - - -
Q9991 - Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg Less than or equal to 100 MG 2016.423 - - - - - -
Q9992 - Injection, buprenorphine extended-release (sublocade), greater than 100 mg Greater than 100 MG 2016.423 - - - - - -
Q9997 - Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg 1 MG 9.287 - - - - - -
Q9998 - Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg 1 MG 40.349 - - - - - -
Q9999 - Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg 1 MG 33.088 - - - - - -
* 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