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 4 * 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
J0577 - Injection, buprenorphine extended-release (brixadi), less than or equal to 7 days of therapy Less than or equal to 7 days of therapy 425.404 - - - - - -
J0578 - Injection, buprenorphine extended release (brixadi), greater than 7 days and up to 28 days of therapy Greater than 7 days and up to 28 days of therapy 1701.615 - - - - - -
J0583 - Injection, bivalirudin, 1 mg 1 MG 0.153 - - - - - -
J0584 - Injection, burosumab-twza 1 mg 1 MG 469.742 - - - - - -
J0585 - Injection, onabotulinumtoxina, 1 unit 1 UNIT 6.478 - - - - - -
J0586 - Injection, abobotulinumtoxina, 5 units 5 Unit 9.044 - - - - - -
J0587 - Injection, rimabotulinumtoxinb, 100 units 100 UNITS 12.996 - - - - - -
J0588 - Injection, incobotulinumtoxin a, 1 unit 1 UNIT 5.33 - - - - - -
J0589 - Injection, daxibotulinumtoxina-lanm, 1 unit 1 UNIT 2.992 - - - - - -
J0592 - Injection, buprenorphine hydrochloride, 0.1 mg 0.1 MG 4.178 - - - - - -
J0593 - Injection, lanadelumab-flyo, 1 mg (code may be used for medicare when drug administered under direct supervision of a physician, not for use when drug is self-administered) 1 mg 84.802 - - - - - -
J0594 - injection, busulfan, 1 mg 1 MG 1.456 - - - - - -
J0595 - Injection, butorphanol tartrate, 1 mg 1 MG 4.692 - - - - - -
J0596 - Injection, c1 esterase inhibitor (recombinant), ruconest, 10 units 10 UNITS 34.75 - - - - - -
J0597 - Injection, c-1 esterase inhibitor (human), berinert, 10 units 10 UNITS 72.267 - - - - - -
J0598 - Injection, c-1 esterase inhibitor (human), cinryze, 10 units 10 UNITS 63.877 - - - - - -
J0600 - Injection, edetate calcium disodium, up to 1000 mg 1000 MG 6460.026 - - - - - -
J0612 - Injection, calcium gluconate, not otherwise specified, 10 mg 10 MG 0.046 - - - - - -
J0613 - Injection, calcium gluconate (wg critical care), not therapeutically equivalent to j0612, 10 mg 10 MG 0.076 - - - - - -
J0637 - Injection, caspofungin acetate, 5 mg 5 MG 3.336 - - - - - -
J0638 - Injection, canakinumab, 1 mg 1 MG 136.557 - - - - - -
J0640 - Injection, leucovorin calcium, per 50 mg 50 MG 3.513 - - - - - -
J0641 - Injection, levoleucovorin, not otherwise specified, 0.5 mg 0.5 MG 0.017 - - - - - -
J0642 - Injection, levoleucovorin (khapzory), 0.5 mg 0.5 MG 1.176 - - - - - -
J0650 - Injection, levothyroxine sodium, not otherwise specified, 10 mcg 10 MCG 7.261 - - - - - -
* 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