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October 4, 2010 - Revised 07.01.11

ASC Drug Fee Schedule - 4th Quarter 2010

HCPCS Code Status Indicator Amount
A9581 A $13.50
A9582 A $2,394.59
A9583 A $12.82
C9121 A $18.85
C9248 A $3.00
C9250 A $122.05
C9254 A $0.16
C9255 A $6.52
C9256 A $196.10
C9257 A $1.43
C9258 A $1.87
C9259 A $165.63
C9260 A $45.47
C9261 A $107.11
C9263 A $275.28
C9264 A $3.48
C9265 A $219.30
C9266 A $375.12
C9267 A $71.19
C9268 A $25.55
C9269 A $27.53
C9270 A $60.42
C9271 A $350.60
C9272 A $14.58
C9273 A $32,860.00
C9356 A $27.77
C9358 A $10.70
C9359 A $63.27
C9360 A $11.26
C9361 A $251.08
C9362 A $50.09
C9363 A $19.56
C9364 A $18.85
C9367 A $4.35
C9399 C $0.00
J0129 A $19.80
J0130 A $481.41
J0132 A $2.67
J0135 A $380.95
J0150 A $9.59
J0152 A $83.41
J0180 A $133.61
J0205 A $41.18
J0207 A $312.65
J0210 A $39.46
J0215 A $32.73
J0220 A $132.64
J0256 A $3.69
J0287 A $9.64
J0288 A $11.77
J0289 A $15.38
J0348 A $1.12
J0365 A $2.60
J0470 A $27.50
J0475 A $200.08
J0476 A $71.77
J0480 A $1,998.30
J0583 A $2.50
J0585 A $5.38
J0586 A $7.55
J0587 A $10.38
J0594 A $16.29
J0598 A $42.75
J0600 A $193.00
J0630 A $50.97
J0637 A $11.87
J0641 A $1.14
J0718 A $3.96
J0735 A $24.28
J0740 A $746.82
J0795 A $4.73
J0800 A $2,395.26
J0833 A $51.32
J0834 A $81.52
J0850 A $862.24
J0878 A $0.44
J0881 A $2.84
J0885 A $9.50
J0894 A $30.16
J0945 A $9.24
J1162 A $496.14
J1190 A $205.25
J1205 A $428.70
J1212 A $69.78
J1267 A $0.55
J1300 A $182.00
J1324 A $0.49
J1327 A $19.72
J1410 A $91.33
J1430 A $147.14
J1436 A $25.02
J1438 A $196.55
J1440 A $229.02
J1441 A $359.89
J1451 A $7.14
J1453 A $1.69
J1457 A $1.99
J1458 A $330.50
J1459 A $35.09
J1460 A $18.53
J1470 A $37.06
J1480 A $55.56
J1490 A $74.11
J1500 A $92.64
J1510 A $111.25
J1520 A $129.58
J1530 A $148.22
J1540 A $166.89
J1550 A $185.28
J1560 A $185.28
J1561 A $36.94
J1562 A $7.03
J1566 A $28.85
J1568 A $36.08
J1569 A $37.77
J1571 A $50.91
J1572 A $35.45
J1573 A $50.91
J1595 A $92.30
J1610 A $84.30
J1620 A $32.12
J1640 A $8.33
J1652 A $6.15
J1670 A $227.91
J1680 A $72.89
J1730 A $45.40
J1740 A $141.46
J1742 A $186.63
J1743 A $446.44
J1745 A $59.39
J1750 A $11.77
J1756 A $0.36
J1785 A $4.12
J1817 A $2.25
J1830 A $181.09
J1930 A $29.47
J1931 A $25.07
J1945 A $275.02
J1950 A $515.53
J1953 A $0.54
J2020 A $32.73
J2248 A $1.05
J2278 A $6.48
J2315 A $2.34
J2320 A $7.08
J2321 A $71.34
J2322 A $43.59
J2323 A $8.60
J2325 A $39.52
J2353 A $109.93
J2355 A $239.98
J2357 A $20.00
J2425 A $11.14
J2430 A $11.81
J2469 A $18.06
J2503 A $1,001.51
J2504 A $242.67
J2505 A $2,418.70
J2513 A $158.77
J2562 A $281.67
J2724 A $12.32
J2730 A $88.96
J2770 A $156.85
J2778 A $397.56
J2783 A $175.88
J2785 A $51.29
J2788 A $22.23
J2790 A $82.74
J2791 A $5.08
J2792 A $17.08
J2793 A $23.64
J2794 A $4.95
J2796 A $45.13
J2820 A $23.43
J2850 A $26.98
J2940 A $4.89
J2941 A $56.96
J2993 A $1,287.73
J2995 A $32.12
J2997 A $37.98
J3030 A $45.71
J3101 A $46.73
J3240 A $1,033.18
J3243 A $1.22
J3246 A $7.89
J3285 A $59.35
J3300 A $3.16
J3305 A $58.36
J3315 A $178.50
J3355 A $58.71
J3365 A $449.09
J3396 A $9.40
J3465 A $5.82
J3487 A $218.89
J3488 A $218.45
J7185 A $1.04
J7186 A $0.90
J7187 A $0.86
J7189 A $1.35
J7190 A $0.87
J7191 A $8.21
J7192 A $1.08
J7193 A $0.88
J7194 A $0.88
J7195 A $1.10
J7197 A $2.49
J7198 A $1.56
J7308 A $136.33
J7310 A $16,640.00
J7311 A $18,980.00
J7321 A $88.81
J7323 A $124.77
J7324 A $171.80
J7325 A $11.72
J7501 A $101.86
J7502 A $3.04
J7504 A $487.57
J7505 A $1,112.13
J7507 A $3.18
J7511 A $409.64
J7513 A $516.41
J7515 A $0.83
J7516 A $20.93
J7517 A $1.48
J7520 A $9.95
J7525 A $136.85
J8501 A $5.73
J8520 A $6.72
J8521 A $22.16
J8560 A $27.95
J8700 A $8.98
J8705 A $77.10
J9001 A $477.62
J9010 A $562.53
J9015 A $904.68
J9017 A $36.55
J9020 A $62.28
J9025 A $5.03
J9027 A $113.23
J9031 A $112.76
J9033 A $18.50
J9035 A $57.34
J9041 A $38.54
J9050 A $172.56
J9055 A $48.80
J9065 A $24.97
J9098 A $461.63
J9120 A $581.24
J9150 A $15.20
J9151 A $56.58
J9155 A $2.52
J9160 A $1,511.90
J9165 A $14.14
J9171 A $17.67
J9178 A $9.17
J9185 A $158.16
J9200 A $32.17
J9201 A $145.55
J9202 A $190.62
J9206 A $4.68
J9207 A $63.74
J9208 A $31.54
J9209 A $4.62
J9211 A $84.06
J9212 A $6.42
J9213 A $10.60
J9214 A $15.76
J9215 A $17.89
J9216 A $422.80
J9217 A $204.29
J9218 A $4.50
J9219 A $4,728.88
J9225 A $1,484.48
J9226 A $15,285.26
J9230 A $151.56
J9245 A $1,375.38
J9261 A $107.39
J9263 A $4.60
J9264 A $9.21
J9266 A $2,675.40
J9268 A $1,205.62
J9280 A $20.38
J9290 A $81.51
J9291 A $163.01
J9293 A $33.48
J9300 A $2,634.68
J9303 A $85.74
J9305 A $50.47
J9310 A $582.67
J9320 A $272.47
J9328 A $4.90
J9330 A $49.87
J9340 A $111.94
J9350 A $1,070.26
J9355 A $66.99
J9357 A $945.02
J9395 A $81.45
J9600 A $2,879.54
P9041 A $16.89
P9045 A $60.58
P9046 A $25.67
P9047 A $62.05
Q0138 A $0.77
Q0515 A $1.77
Q2004 A $5.11
Q2017 A $317.55
Q2025 A $8.01
Q3025 A $210.25
Q4101 A $33.45
Q4102 A $4.34
Q4103 A $4.34
Q4104 A $14.77
Q4105 A $10.03
Q4106 A $39.35
Q4107 A $93.33
Q4108 A $18.86
Q4110 A $34.38
Q4111 A $6.97
Q4112 A $346.71
Q4113 A $346.71
Q4114 A $957.53
Q4115 A $6.57
Q4116 A $32.01
Q9968 A $1.43
90371 A $113.10
90375 A $163.55
90376 A $158.19
90378 A $510.69
90396 A $147.58
90476 A $72.17
90585 A $109.88
90665 A $0.93
90675 A $198.75
90676 A $96.27
90680 A $72.37
90681 A $100.57
90725 A $103.90
90733 A $101.46
90734 A $94.15
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 2009 by the American Medical Association.

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