ASP Drug Pricing - (3rd Quarter)
July 2025
Payment Allowance Limits for Medicare Part B Drugs

  • Note 1: Payment allowance limits subject to the ASP methodology are based on Jan 2025 (1st 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 2 * Effective Jul 1, 2025 through Sep 30, 2025
HCPCS Code Code Dosage Payment
Limit		 Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
J0169 - Injection, epinephrine (adrenalin), not therapeutically equivalent to j0165, 0.1 mg 0.1 MG 1.32 - - - - - -
J0172 - Injection, aducanumab-avwa, 2 mg 2 MG 5.978 - - - - - -
J0174 - Lecanemab-irmb, for intravenous injection, 1 mg 1 MG 1.327 - - - - - -
J0175 - Injection, donanemab-azbt, 2 mg 2 MG 4.143 - - - - - -
J0177 - Injection, aflibercept hd, 1 mg 1 MG 319.738 - - - - - -
J0178 - Injection, aflibercept, 1 mg 1 MG 790.037 - - - - - -
J0179 - Injection, brolucizumab-dbll, 1 mg 1 MG 346.194 - - - - - -
J0180 - Injection, agalsidase beta, 1 mg 1 MG 230.262 - - - - - -
J0185 - Injection, aprepitant, 1 mg 1 MG 1.773 - - - - - -
J0202 - Injection, alemtuzumab, 1 mg 1 MG 2440.702 - - - - - -
J0206 - Injection, allopurinol sodium, 1 mg 1 MG 4.542 - - - - - -
J0217 - Injection, velmanase alfa-tycv, 1 mg 1 MG 465.049 - - - - - -
J0218 - Injection, olipudase alfa-rpcp, 1 mg 1 MG 393.823 - - - - - -
J0219 - Injection, avalglucosidase alfa-ngpt, 4 mg 4 MG 80.752 - - - - - -
J0221 - Injection, alglucosidase alfa, (lumizyme), 10 mg 10 MG 206.615 - - - - - -
J0222 - Injection, patisiran, 0.1 mg 0.1 MG 99.819 - - - - - -
J0223 - Injection, givosiran, 0.5 mg 0.5 MG 117.19 - - - - - -
J0224 - Injection, lumasiran, 0.5 mg 0.5 MG 329.103 - - - - - -
J0225 - Injection, vutrisiran, 1 mg 1 MG 4983.855 - - - - - -
J0248 - Injection, remdesivir, 1 mg 1 MG 6.729 - - - - - -
J0256 - Injection, alpha 1 proteinase inhibitor (human), not otherwise specified, 10 mg 10 MG 5.185 - - - - - -
J0257 - Injection, alpha 1 proteinase inhibitor (human), (glassia), 10 mg 10 MG 5.713 - - - - - -
J0278 - Injection, amikacin sulfate, 100 mg 100 MG 0.617 - - - - - -
J0280 - Injection, aminophyllin, up to 250 mg 250 MG 8.299 - - - - - -
J0281 - Injection, aminocaproic acid, 1 gram 1 GM 1.495 - - - - - -
* Effective Jul 1, 2025 through Sep 30, 2025

Drugs not otherwise classified - July 2025

 

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

Drug name Dosage Payment limit Notes
Vasopressin (Long Grove) 1 UNIT 2.796

ASP (Average Sale Price) Drug Pricing History