ASP Pricing Files
CMS may not publish an ASP-based payment limit or crosswalk for all drugs that are reported by manufacturers. The absence or presence of a HCPCS, NDC code, and/or the payment limits in the ASP Pricing Files does not indicate whether Medicare covers a particular product. Even if a product does not appear on a quarter’s ASP pricing files, the local Medicare Administrative Contractor (MAC) may process the Part B claim after determining the payment limit, provided that the claim is reasonable and necessary and meets all necessary requirements for payment. For additional information about the payment limit for new drugs and biological products during the initial period of marketing, refer to regulations at 42 CFR § 414.904(e)(4) and rulemaking in the CY 2019 PFS final rule (83 FR 59661 through 59666) and the CY 2024 PFS final rule (88 FR 79040 through 79042).
The quarterly ASP Pricing Files are grouped by the year in which they are effective. For more information on how ASP is reported, and what drugs and biologicals are included in the ASP Pricing Files, visit the ASP Reporting page: