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 3 * 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
J0289 - Injection, amphotericin b liposome, 10 mg 10 MG 21.483 - - - - - -
J0290 - Injection, ampicillin sodium, 500 mg 500 MG 0.546 - - - - - -
J0291 - Injection, plazomicin, 5 mg 5 MG 3.504 - - - - - -
J0295 - Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm 1.5 GM 1.392 - - - - - -
J0348 - Injection, anidulafungin, 1 mg 1 MG 0.518 - - - - - -
J0349 - Injection, rezafungin, 1 mg 1 MG 10.625 - - - - - -
J0360 - Injection, hydralazine hcl, up to 20 mg 20 MG 5.601 - - - - - -
J0401 - Injection, aripiprazole (abilify maintena), 1 mg 1 MG 7.276 - - - - - -
J0402 - Injection, aripiprazole (abilify asimtufii), 1 mg 1 MG 6.027 - - - - - -
J0456 - Injection, azithromycin, 500 mg 500 MG 2.036 - - - - - -
J0457 - Injection, aztreonam, 100 mg 100 MG 2.533 - - - - - -
J0461 - Injection, atropine sulfate, 0.01 mg 0.01 MG 0.1 - - - - - -
J0462 - Injection, atropine sulfate, not therapeutically equivalent to j0461, 0.01 mg 0.01 MG 0.135 - - - - - -
J0475 - Injection, baclofen, 10 mg 10 MG 181.222 - - - - - -
J0476 - Injection, baclofen, 50 mcg for intrathecal trial 50 MCG 49.952 - - - - - -
J0480 - Injection, basiliximab, 20 mg 20 MG 4686.854 - - - - - -
J0485 - Injection, belatacept, 1 mg 1 MG 3.887 - - - - - -
J0490 - Injection, belimumab, 10 mg 10 MG 56.068 - - - - - -
J0491 - Injection, anifrolumab-fnia, 1 mg 1 MG 18.079 - - - - - -
J0500 - Injection, dicyclomine hcl, up to 20 mg 20 MG 11.358 - - - - - -
J0515 - Injection, benztropine mesylate, per 1 mg 1 MG 15.325 - - - - - -
J0517 - Injection, benralizumab, 1 mg 1 MG 164.588 - - - - - -
J0558 - Injection, penicillin g benzathine and penicillin g procaine, 100,000 units 100,000 UNITS 19.523 - - - - - -
J0561 - Injection, penicillin g benzathine, 100,000 units 100,000 UNITS 30.011 - - - - - -
J0565 - Injection, bezlotoxumab, 10 mg 10 MG 39.825 - - - - - -
* 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