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 3 * 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
J0282 - Injection, amiodarone hydrochloride, 30 mg 30 MG 0.506 - - - - - -
J0283 - Injection, amiodarone hydrochloride (nexterone), 30 mg 30 MG 2.611 - - - - - -
J0285 - Injection, amphotericin b, 50 mg 50 MG 34.124 - - - - - -
J0287 - Injection, amphotericin b lipid complex, 10 mg 10 MG 10.299 - - - - - -
J0289 - Injection, amphotericin b liposome, 10 mg 10 MG 22.616 - - - - - -
J0290 - Injection, ampicillin sodium, 500 mg 500 MG 0.489 - - - - - -
J0291 - Injection, plazomicin, 5 mg 5 MG 3.574 - - - - - -
J0295 - Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm 1.5 GM 1.494 - - - - - -
J0348 - Injection, anidulafungin, 1 mg 1 MG 0.484 - - - - - -
J0349 - Injection, rezafungin, 1 mg 1 MG 10.617 - - - - - -
J0360 - Injection, hydralazine hcl, up to 20 mg 20 MG 5.188 - - - - - -
J0401 - Injection, aripiprazole (abilify maintena), 1 mg 1 MG 7.236 - - - - - -
J0402 - Injection, aripiprazole (abilify asimtufii), 1 mg 1 MG 6.034 - - - - - -
J0456 - Injection, azithromycin, 500 mg 500 MG 2.614 - - - - - -
J0457 - Injection, aztreonam, 100 mg 100 MG 2.665 - - - - - -
J0461 - Injection, atropine sulfate, 0.01 mg 0.01 MG 0.066 - - - - - -
J0475 - Injection, baclofen, 10 mg 10 MG 175.819 - - - - - -
J0476 - Injection, baclofen, 50 mcg for intrathecal trial 50 MCG 67.203 - - - - - -
J0480 - Injection, basiliximab, 20 mg 20 MG 4672.467 - - - - - -
J0485 - Injection, belatacept, 1 mg 1 MG 3.888 - - - - - -
J0490 - Injection, belimumab, 10 mg 10 MG 56.006 - - - - - -
J0491 - Injection, anifrolumab-fnia, 1 mg 1 MG 18.104 - - - - - -
J0500 - Injection, dicyclomine hcl, up to 20 mg 20 MG 11.675 - - - - - -
J0515 - Injection, benztropine mesylate, per 1 mg 1 MG 17.267 - - - - - -
J0517 - Injection, benralizumab, 1 mg 1 MG 168.13 - - - - - -
* 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