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 7 * 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
J0872 - Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent to j0878 or j0873, 1 mg 1 MG 0.038 - - - - - -
J0873 - Injection, daptomycin (xellia), not therapeutically equivalent to j0878 or j0872, 1 mg 1 MG 0.035 - - - - - -
J0874 - Injection, daptomycin (baxter), not therapeutically equivalent to j0878, 1 mg 1 MG 0.059 - - - - - -
J0875 - Injection, dalbavancin, 5 mg 5 MG 15.613 - - - - - -
J0877 - Injection, daptomycin (hospira), not therapeutically equivalent to j0878, 1 mg 1 MG 0.058 - - - - - -
J0878 - Injection, daptomycin, 1 mg 1 MG 0.028 - - - - - -
J0881 - Injection, darbepoetin alfa, 1 microgram (non-esrd use) 1 MCG 2.926 - - - - - -
J0882 - Injection, darbepoetin alfa, 1 microgram (for esrd on dialysis) 1 MCG 2.926 - - - - - -
J0883 - Injection, argatroban, 1 mg (for non-esrd use) 1 MG 0.796 - - - - - -
J0884 - Injection, argatroban, 1 mg (for esrd on dialysis) 1 MG 0.796 - - - - - -
J0885 - Injection, epoetin alfa, (for non-esrd use), 1000 units 1000 UNITS 8.544 - - - - - -
J0887 - Injection, epoetin beta, 1 microgram, (for esrd on dialysis) 1 MCG 1.465 - - - - - -
J0888 - Injection, epoetin beta, 1 microgram, (for non esrd use) 1 MCG 1.465 - - - - - -
J0893 - Injection, decitabine (sun pharma), not therapeutically equivalent to j0894, 1 mg 1 MG 0.777 - - - - - -
J0894 - Injection, decitabine, 1 mg 1 MG 1.218 - - - - - -
J0895 - Injection, deferoxamine mesylate, 500 mg 500 MG 9.009 - - - - - -
J0896 - Injection, luspatercept-aamt, 0.25 mg 0.25 MG 41.982 - - - - - -
J0897 - Injection, denosumab, 1 mg 1 MG 29.38 - - - - - -
J0898 - Injection, argatroban (auromedics), not therapeutically equivalent to j0883, 1 mg (for non-esrd use) 1 MG 1.623 - - - - - -
J0899 - Injection, argatroban (auromedics), not therapeutically equivalent to j0884, 1 mg (for esrd on dialysis) 1 MG 1.623 - - - - - -
J0901 - Vadadustat, oral, 1 mg (for esrd on dialysis) 1 MG 0.143 - - - - - -
J1000 - Injection, depo-estradiol cypionate, up to 5 mg 5 MG 49.278 - - - - - -
J1010 - Injection, methylprednisolone acetate, 1 mg 1 MG 0.119 - - - - - -
J1071 - Injection, testosterone cypionate, 1 mg 1 MG 0.028 - - - - - -
J1072 - Injection, testosterone cypionate (azmiro), 1 mg 1 MG 1.325 - - - - - -
* 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