January 3, 2011
July 2010 3rd QTR ASC Drug File — Revised 07/01/2011
Revised 07.01.2011
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9581 | A | $13.50 |
| A9582 | A | $2,398.69 |
| A9583 | A | $12.89 |
| C9121 | A | $19.12 |
| C9248 | A | $3.07 |
| C9250 | A | $136.21 |
| C9254 | A | $0.16 |
| C9255 | A | $6.53 |
| C9256 | A | $196.10 |
| C9257 | A | $1.43 |
| C9258 | A | $1.81 |
| C9259 | A | $165.63 |
| C9260 | A | $45.52 |
| C9261 | A | $107.41 |
| C9263 | A | $280.90 |
| C9264 | A | $3.52 |
| C9265 | A | $223.78 |
| C9266 | A | $382.78 |
| C9267 | A | $122.07 |
| C9268 | A | $25.55 |
| C9356 | A | $30.17 |
| C9358 | A | $10.65 |
| C9359 | A | $59.91 |
| C9360 | A | $11.31 |
| C9361 | A | $252.18 |
| C9362 | A | $50.33 |
| C9363 | A | $19.87 |
| C9364 | A | $17.48 |
| C9367 | A | $4.35 |
| C9399 | C | $0.00 |
| J0129 | A | $19.45 |
| J0130 | A | $481.04 |
| J0132 | A | $2.44 |
| J0135 | A | $367.21 |
| J0150 | A | $11.47 |
| J0152 | A | $83.38 |
| J0180 | A | $133.62 |
| J0205 | A | $41.18 |
| J0207 | A | $333.77 |
| J0210 | A | $37.60 |
| J0215 | A | $30.07 |
| J0220 | A | $124.63 |
| J0256 | A | $3.69 |
| J0287 | A | $9.81 |
| J0288 | A | $11.77 |
| J0289 | A | $15.43 |
| J0348 | A | $1.40 |
| J0365 | A | $2.60 |
| J0470 | A | $27.31 |
| J0475 | A | $201.35 |
| J0476 | A | $71.99 |
| J0480 | A | $1,957.56 |
| J0583 | A | $2.47 |
| J0585 | A | $5.39 |
| J0586 | A | $7.49 |
| J0587 | A | $10.38 |
| J0594 | A | $16.21 |
| J0598 | A | $42.75 |
| J0600 | A | $193.65 |
| J0630 | A | $51.04 |
| J0637 | A | $11.71 |
| J0641 | A | $0.73 |
| J0718 | A | $3.79 |
| J0735 | A | $77.15 |
| J0740 | A | $751.97 |
| J0795 | A | $4.92 |
| J0800 | A | $2,395.60 |
| J0833 | A | $63.50 |
| J0834 | A | $87.06 |
| J0850 | A | $862.24 |
| J0878 | A | $0.42 |
| J0881 | A | $2.91 |
| J0885 | A | $9.48 |
| J0894 | A | $29.53 |
| J0945 | A | $9.24 |
| J1162 | A | $503.46 |
| J1190 | A | $250.35 |
| J1205 | A | $367.09 |
| J1212 | A | $69.22 |
| J1267 | A | $0.55 |
| J1300 | A | $182.00 |
| J1324 | A | $0.49 |
| J1327 | A | $19.38 |
| J1410 | A | $91.34 |
| J1430 | A | $147.14 |
| J1436 | A | $25.02 |
| J1438 | A | $190.47 |
| J1440 | A | $225.75 |
| J1441 | A | $354.07 |
| J1451 | A | $7.44 |
| J1453 | A | $1.67 |
| J1457 | A | $1.98 |
| J1458 | A | $331.35 |
| J1459 | A | $35.09 |
| J1460 | A | $17.76 |
| J1470 | A | $35.51 |
| J1480 | A | $53.26 |
| J1490 | A | $71.02 |
| J1500 | A | $88.78 |
| J1510 | A | $106.57 |
| J1520 | A | $124.22 |
| J1530 | A | $142.05 |
| J1540 | A | $159.88 |
| J1550 | A | $177.56 |
| J1560 | A | $177.56 |
| J1561 | A | $36.96 |
| J1562 | A | $7.13 |
| J1566 | A | $30.15 |
| J1568 | A | $36.79 |
| J1569 | A | $37.73 |
| J1571 | A | $50.44 |
| J1572 | A | $35.99 |
| J1573 | A | $50.44 |
| J1595 | A | $88.65 |
| J1610 | A | $83.75 |
| J1620 | A | $32.12 |
| J1640 | A | $8.31 |
| J1652 | A | $5.86 |
| J1670 | A | $223.98 |
| J1680 | A | $72.89 |
| J1730 | A | $112.16 |
| J1740 | A | $141.29 |
| J1742 | A | $268.61 |
| J1743 | A | $446.44 |
| J1745 | A | $57.48 |
| J1750 | A | $12.29 |
| J1756 | A | $0.36 |
| J1785 | A | $4.12 |
| J1817 | A | $2.15 |
| J1830 | A | $172.05 |
| J1930 | A | $28.71 |
| J1931 | A | $25.07 |
| J1945 | A | $229.88 |
| J1950 | A | $516.42 |
| J1953 | A | $0.53 |
| J2020 | A | $32.62 |
| J2248 | A | $1.07 |
| J2278 | A | $6.46 |
| J2315 | A | $2.37 |
| J2320 | A | $7.08 |
| J2321 | A | $71.34 |
| J2322 | A | $43.59 |
| J2323 | A | $8.66 |
| J2325 | A | $39.38 |
| J2353 | A | $109.12 |
| J2355 | A | $240.07 |
| J2357 | A | $19.43 |
| J2425 | A | $11.17 |
| J2430 | A | $15.12 |
| J2469 | A | $18.59 |
| J2503 | A | $1,005.28 |
| J2504 | A | $242.67 |
| J2505 | A | $2,423.91 |
| J2513 | A | $158.77 |
| J2562 | A | $267.86 |
| J2724 | A | $12.11 |
| J2730 | A | $87.59 |
| J2770 | A | $152.69 |
| J2778 | A | $397.42 |
| J2783 | A | $172.40 |
| J2785 | A | $51.27 |
| J2788 | A | $26.90 |
| J2790 | A | $85.35 |
| J2791 | A | $5.08 |
| J2792 | A | $19.57 |
| J2793 | A | $23.64 |
| J2794 | A | $4.96 |
| J2796 | A | $44.24 |
| J2820 | A | $25.07 |
| J2850 | A | $26.97 |
| J2940 | A | $4.89 |
| J2941 | A | $56.78 |
| J2993 | A | $1,339.98 |
| J2995 | A | $32.12 |
| J2997 | A | $38.14 |
| J3030 | A | $47.02 |
| J3101 | A | $46.10 |
| J3240 | A | $1,033.74 |
| J3243 | A | $1.20 |
| J3246 | A | $7.73 |
| J3285 | A | $54.83 |
| J3300 | A | $3.16 |
| J3305 | A | $58.36 |
| J3315 | A | $161.48 |
| J3355 | A | $59.76 |
| J3365 | A | $449.09 |
| J3396 | A | $9.31 |
| J3465 | A | $5.79 |
| J3487 | A | $217.34 |
| J3488 | A | $218.72 |
| J7185 | A | $1.02 |
| J7186 | A | $0.90 |
| J7187 | A | $0.85 |
| J7189 | A | $1.35 |
| J7190 | A | $0.86 |
| J7191 | A | $8.21 |
| J7192 | A | $1.08 |
| J7193 | A | $0.89 |
| J7194 | A | $0.84 |
| J7195 | A | $1.09 |
| J7197 | A | $2.51 |
| J7198 | A | $1.56 |
| J7308 | A | $133.85 |
| J7310 | A | $16,640.00 |
| J7311 | A | $18,980.00 |
| J7321 | A | $87.67 |
| J7323 | A | $115.09 |
| J7324 | A | $171.18 |
| J7325 | A | $11.54 |
| J7501 | A | $95.32 |
| J7502 | A | $3.30 |
| J7504 | A | $497.22 |
| J7505 | A | $1,112.43 |
| J7507 | A | $3.26 |
| J7511 | A | $393.84 |
| J7513 | A | $516.41 |
| J7515 | A | $0.84 |
| J7516 | A | $23.90 |
| J7517 | A | $1.31 |
| J7520 | A | $9.88 |
| J7525 | A | $136.82 |
| J8501 | A | $5.71 |
| J8520 | A | $6.73 |
| J8521 | A | $22.05 |
| J8560 | A | $27.80 |
| J8700 | A | $8.92 |
| J8705 | A | $74.59 |
| J9001 | A | $478.78 |
| J9010 | A | $577.35 |
| J9015 | A | $867.20 |
| J9017 | A | $36.67 |
| J9020 | A | $59.81 |
| J9025 | A | $4.91 |
| J9027 | A | $114.27 |
| J9031 | A | $108.23 |
| J9033 | A | $18.55 |
| J9035 | A | $57.34 |
| J9041 | A | $38.54 |
| J9050 | A | $172.83 |
| J9055 | A | $48.80 |
| J9065 | A | $25.61 |
| J9098 | A | $459.10 |
| J9120 | A | $560.14 |
| J9150 | A | $30.69 |
| J9151 | A | $56.58 |
| J9155 | A | $2.42 |
| J9160 | A | $1,515.18 |
| J9165 | A | $14.14 |
| J9171 | A | $17.69 |
| J9178 | A | $2.19 |
| J9185 | A | $112.61 |
| J9200 | A | $34.99 |
| J9201 | A | $145.83 |
| J9202 | A | $194.34 |
| J9206 | A | $3.36 |
| J9207 | A | $63.74 |
| J9208 | A | $29.83 |
| J9209 | A | $4.15 |
| J9211 | A | $41.14 |
| J9212 | A | $4.71 |
| J9213 | A | $10.60 |
| J9214 | A | $15.50 |
| J9215 | A | $17.89 |
| J9216 | A | $422.80 |
| J9217 | A | $201.56 |
| J9218 | A | $4.03 |
| J9219 | A | $4,728.88 |
| J9225 | A | $1,399.87 |
| J9226 | A | $14,579.91 |
| J9230 | A | $151.51 |
| J9245 | A | $1,378.16 |
| J9261 | A | $103.78 |
| J9263 | A | $4.35 |
| J9264 | A | $9.22 |
| J9266 | A | $2,664.22 |
| J9268 | A | $1,243.62 |
| J9280 | A | $19.80 |
| J9290 | A | $79.21 |
| J9291 | A | $158.43 |
| J9293 | A | $44.38 |
| J9300 | A | $2,637.13 |
| J9303 | A | $85.60 |
| J9305 | A | $50.71 |
| J9310 | A | $568.28 |
| J9320 | A | $275.26 |
| J9328 | A | $4.90 |
| J9330 | A | $49.86 |
| J9340 | A | $111.46 |
| J9350 | A | $1,038.76 |
| J9355 | A | $65.30 |
| J9357 | A | $944.43 |
| J9395 | A | $81.47 |
| J9600 | A | $2,931.54 |
| P9041 | A | $16.89 |
| P9045 | A | $60.58 |
| P9046 | A | $25.67 |
| P9047 | A | $62.05 |
| Q0138 | A | $0.79 |
| Q0515 | A | $1.77 |
| Q2004 | A | $5.11 |
| Q2017 | A | $318.15 |
| Q2025 | A | $8.18 |
| Q3025 | A | $190.25 |
| Q4101 | A | $33.42 |
| Q4102 | A | $4.31 |
| Q4103 | A | $4.31 |
| Q4104 | A | $15.65 |
| Q4105 | A | $9.14 |
| Q4106 | A | $39.33 |
| Q4107 | A | $92.93 |
| Q4108 | A | $18.81 |
| Q4110 | A | $33.77 |
| Q4111 | A | $7.29 |
| Q4112 | A | $340.59 |
| Q4113 | A | $340.59 |
| Q4114 | A | $943.05 |
| Q4115 | A | $7.17 |
| Q4116 | A | $32.28 |
| Q9968 | A | $1.19 |
| 90371 | A | $113.58 |
| 90375 | A | $158.04 |
| 90376 | A | $158.08 |
| 90378 | A | $510.69 |
| 90396 | A | $147.58 |
| 90476 | A | $72.17 |
| 90585 | A | $108.09 |
| 90665 | A | $0.93 |
| 90675 | A | $171.36 |
| 90676 | A | $96.27 |
| 90680 | A | $72.37 |
| 90681 | A | $100.57 |
| 90725 | A | $103.90 |
| 90733 | A | $101.46 |
| 90734 | A | $107.55 |
| 90735 | A | $100.15 |
| 90740 | C | $0.00 |
| 90743 | C | $0.00 |
| 90744 | C | $0.00 |
| 90746 | C | $0.00 |
| 90747 | C | $0.00 |
All CPT codes begin with a numeric character and all HCPCS codes begin with an alpha character.
All Current Procedural Terminology (CPT) codes and descriptors are copyrighted 2010 by the American Medical Association.

