ASP Drug Pricing - (2nd Quarter)
April 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Oct 2024 (4th 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 3 * Effective April 1, 2025 through June 30, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J0287 - Injection, amphotericin b lipid complex, 10 mg 10 MG 10.299 - - - - - -
J0289 - Injection, amphotericin b liposome, 10 mg 10 MG 23.307 - - - - - -
J0290 - Injection, ampicillin sodium, 500 mg 500 MG 0.597 - - - - - -
J0291 - Injection, plazomicin, 5 mg 5 MG 3.574 - - - - - -
J0295 - Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm 1.5 GM 1.573 - - - - - -
J0348 - Injection, anidulafungin, 1 mg 1 MG 0.472 - - - - - -
J0349 - Injection, rezafungin, 1 mg 1 MG 10.418 - - - - - -
J0360 - Injection, hydralazine hcl, up to 20 mg 20 MG 4.402 - - - - - -
J0401 - Injection, aripiprazole (abilify maintena), 1 mg 1 MG 7.033 - - - - - -
J0402 - Injection, aripiprazole (abilify asimtufii), 1 mg 1 MG 5.872 - - - - - -
J0456 - Injection, azithromycin, 500 mg 500 MG 2.221 - - - - - -
J0457 - Injection, aztreonam, 100 mg 100 MG 2.478 - - - - - -
J0461 - Injection, atropine sulfate, 0.01 mg 0.01 MG 0.111 - - - - - -
J0475 - Injection, baclofen, 10 mg 10 MG 174.804 - - - - - -
J0476 - Injection, baclofen, 50 mcg for intrathecal trial 50 MCG 53.819 - - - - - -
J0480 - Injection, basiliximab, 20 mg 20 MG 4687.658 - - - - - -
J0485 - Injection, belatacept, 1 mg 1 MG 3.891 - - - - - -
J0490 - Injection, belimumab, 10 mg 10 MG 54.968 - - - - - -
J0491 - Injection, anifrolumab-fnia, 1 mg 1 MG 17.777 - - - - - -
J0500 - Injection, dicyclomine hcl, up to 20 mg 20 MG 12.857 - - - - - -
J0515 - Injection, benztropine mesylate, per 1 mg 1 MG 16.765 - - - - - -
J0517 - Injection, benralizumab, 1 mg 1 MG 163.3 - - - - - -
J0558 - Injection, penicillin g benzathine and penicillin g procaine, 100,000 units 100,000 UNITS 17.368 - - - - - -
J0561 - Injection, penicillin g benzathine, 100,000 units 100,000 UNITS 26.984 - - - - - -
J0565 - Injection, bezlotoxumab, 10 mg 10 MG 39.869 - - - - - -
* Effective April 1, 2025 through June 30, 2025

Drugs not otherwise classified - April 2025

 

Medicare Part B payment allowance limits for drugs not otherwise classified - Effective April 1, 2025 through June 30, 2025

Drug name Dosage Payment limit Notes
Diltiazem Hydrochloride 5 MG 0.416
Metoprolol Tartrate 1 MG 0.123
Vasopressin (Long Grove) 1 UNIT 3.272 Added April 2025

ASP (Average Sale Price) Drug Pricing History