October 3, 2011 - Revised: April 2012
October 2011 4th QTR ASC Drug File
Effective 10.01.2011
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9582 | A | $2,636.16 |
| A9583 | A | $12.65 |
| C9121 | A | $20.35 |
| C9248 | A | $2.68 |
| C9250 | A | $132.21 |
| C9254 | A | $0.15 |
| C9257 | A | $1.51 |
| C9270 | A | $37.29 |
| C9272 | A | $14.47 |
| C9274 | A | $2,111.36 |
| C9275 | A | $623.28 |
| C9276 | A | $135.57 |
| C9277 | A | $14.83 |
| C9279 | A | $1.62 |
| C9280 | A | $900.58 |
| C9281 | A | $301.75 |
| C9282 | A | $0.74 |
| C9283 | A | $0.11 |
| C9284 | A | $127.20 |
| C9285 | A | $13.57 |
| C9286 | A | $3.91 |
| C9358 | A | $11.01 |
| C9360 | A | $11.44 |
| C9361 | A | $239.46 |
| C9362 | A | $51.87 |
| C9363 | A | $20.99 |
| C9364 | A | $17.44 |
| C9365 | A | $10.39 |
| C9367 | A | $4.35 |
| C9399 | C | $0.00 |
| C9406 | A | $1,908.00 |
| J0129 | A | $20.92 |
| J0130 | A | $554.23 |
| J0132 | A | $2.77 |
| J0135 | A | $414.90 |
| J0152 | A | $95.33 |
| J0180 | A | $139.86 |
| J0205 | A | $41.63 |
| J0207 | A | $318.98 |
| J0210 | A | $39.53 |
| J0215 | A | $39.10 |
| J0220 | A | $157.34 |
| J0256 | A | $3.87 |
| J0287 | A | $8.50 |
| J0288 | A | $14.70 |
| J0289 | A | $14.38 |
| J0348 | A | $1.22 |
| J0475 | A | $189.26 |
| J0476 | A | $77.13 |
| J0480 | A | $2,211.64 |
| J0515 | A | $25.57 |
| J0583 | A | $2.74 |
| J0585 | A | $5.43 |
| J0586 | A | $7.36 |
| J0587 | A | $10.88 |
| J0594 | A | $18.90 |
| J0597 | A | $30.23 |
| J0598 | A | $44.20 |
| J0600 | A | $191.29 |
| J0630 | A | $56.50 |
| J0637 | A | $13.45 |
| J0638 | A | $88.97 |
| J0641 | A | $1.61 |
| J0718 | A | $4.20 |
| J0735 | A | $30.54 |
| J0740 | A | $749.81 |
| J0775 | A | $37.51 |
| J0795 | A | $5.63 |
| J0800 | A | $2,540.41 |
| J0833 | A | $100.72 |
| J0834 | A | $68.38 |
| J0850 | A | $956.97 |
| J0878 | A | $0.48 |
| J0881 | A | $3.17 |
| J0885 | A | $9.80 |
| J0894 | A | $32.25 |
| J0945 | A | $7.50 |
| J1162 | A | $632.74 |
| J1190 | A | $209.92 |
| J1205 | A | $272.46 |
| J1212 | A | $84.86 |
| J1290 | A | $289.07 |
| J1300 | A | $188.16 |
| J1327 | A | $22.23 |
| J1410 | A | $104.54 |
| J1430 | A | $297.11 |
| J1438 | A | $206.27 |
| J1440 | A | $249.18 |
| J1441 | A | $393.82 |
| J1451 | A | $6.97 |
| J1453 | A | $1.71 |
| J1457 | A | $2.05 |
| J1458 | A | $344.68 |
| J1459 | A | $34.75 |
| J1460 | A | $20.81 |
| J1559 | A | $7.22 |
| J1560 | A | $208.14 |
| J1561 | A | $37.13 |
| J1562 | A | $12.60 |
| J1566 | A | $30.75 |
| J1568 | A | $56.34 |
| J1569 | A | $37.43 |
| J1571 | A | $52.61 |
| J1572 | A | $35.15 |
| J1573 | A | $52.61 |
| J1595 | A | $110.35 |
| J1610 | A | $102.27 |
| J1640 | A | $10.51 |
| J1670 | A | $247.38 |
| J1680 | A | $72.94 |
| J1730 | A | $1.04 |
| J1740 | A | $149.44 |
| J1742 | A | $126.92 |
| J1743 | A | $450.74 |
| J1745 | A | $62.61 |
| J1750 | A | $11.65 |
| J1756 | A | $0.32 |
| J1786 | A | $41.59 |
| J1830 | A | $213.62 |
| J1930 | A | $31.28 |
| J1931 | A | $26.58 |
| J1945 | A | $349.51 |
| J1950 | A | $596.39 |
| J2020 | A | $34.82 |
| J2170 | A | $25.90 |
| J2248 | A | $0.99 |
| J2278 | A | $6.54 |
| J2315 | A | $2.81 |
| J2320 | A | $9.27 |
| J2323 | A | $10.42 |
| J2325 | A | $46.80 |
| J2353 | A | $118.24 |
| J2355 | A | $242.20 |
| J2357 | A | $21.54 |
| J2358 | A | $2.73 |
| J2425 | A | $11.56 |
| J2426 | A | $6.68 |
| J2469 | A | $19.01 |
| J2503 | A | $1,010.97 |
| J2504 | A | $250.95 |
| J2505 | A | $2,702.23 |
| J2510 | A | $12.17 |
| J2513 | A | $13.36 |
| J2562 | A | $281.10 |
| J2700 | A | $2.53 |
| J2724 | A | $13.02 |
| J2730 | A | $89.37 |
| J2770 | A | $173.13 |
| J2778 | A | $399.33 |
| J2783 | A | $190.79 |
| J2785 | A | $51.71 |
| J2788 | A | $21.73 |
| J2790 | A | $82.93 |
| J2791 | A | $5.14 |
| J2792 | A | $17.37 |
| J2793 | A | $23.86 |
| J2794 | A | $5.12 |
| J2796 | A | $46.31 |
| J2805 | A | $75.45 |
| J2820 | A | $24.45 |
| J2850 | A | $27.23 |
| J2941 | A | $62.41 |
| J2993 | A | $1,639.20 |
| J2995 | A | $47.57 |
| J2997 | A | $42.64 |
| J3095 | A | $2.10 |
| J3101 | A | $57.70 |
| J3240 | A | $1,042.18 |
| J3243 | A | $1.31 |
| J3246 | A | $9.01 |
| J3262 | A | $3.47 |
| J3285 | A | $60.66 |
| J3300 | A | $3.45 |
| J3310 | A | $30.91 |
| J3315 | A | $177.87 |
| J3350 | A | $82.18 |
| J3355 | A | $66.29 |
| J3357 | A | $117.56 |
| J3365 | A | $453.41 |
| J3385 | A | $349.51 |
| J3396 | A | $9.86 |
| J3465 | A | $6.13 |
| J3487 | A | $222.41 |
| J3488 | A | $220.54 |
| J7185 | A | $1.08 |
| J7186 | A | $0.91 |
| J7187 | A | $0.88 |
| J7189 | A | $1.53 |
| J7190 | A | $0.85 |
| J7191 | A | $1.17 |
| J7192 | A | $1.10 |
| J7193 | A | $0.89 |
| J7194 | A | $0.91 |
| J7195 | A | $1.15 |
| J7196 | A | $102.38 |
| J7197 | A | $2.74 |
| J7198 | A | $1.62 |
| J7308 | A | $149.23 |
| J7309 | A | $75.23 |
| J7310 | A | $16,800.00 |
| J7311 | A | $19,162.50 |
| J7312 | A | $195.96 |
| J7321 | A | $88.85 |
| J7323 | A | $147.50 |
| J7324 | A | $167.74 |
| J7325 | A | $12.04 |
| J7335 | A | $25.55 |
| J7501 | A | $123.71 |
| J7504 | A | $561.86 |
| J7505 | A | $1,122.28 |
| J7511 | A | $436.36 |
| J7513 | A | $521.38 |
| J7525 | A | $138.18 |
| J8501 | A | $6.12 |
| J8510 | A | $3.80 |
| J8520 | A | $7.39 |
| J8521 | A | $24.86 |
| J8560 | A | $37.90 |
| J8562 | A | $77.93 |
| J8700 | A | $9.57 |
| J8705 | A | $79.42 |
| J9001 | A | $530.40 |
| J9010 | A | $580.71 |
| J9015 | A | $978.93 |
| J9017 | A | $40.48 |
| J9020 | A | $62.67 |
| J9025 | A | $5.20 |
| J9027 | A | $120.84 |
| J9031 | A | $118.47 |
| J9033 | A | $18.65 |
| J9035 | A | $60.56 |
| J9041 | A | $41.06 |
| J9050 | A | $174.18 |
| J9055 | A | $50.00 |
| J9065 | A | $24.17 |
| J9098 | A | $508.33 |
| J9120 | A | $572.74 |
| J9150 | A | $15.75 |
| J9151 | A | $57.12 |
| J9155 | A | $2.76 |
| J9160 | A | $1,618.43 |
| J9171 | A | $15.90 |
| J9178 | A | $1.89 |
| J9185 | A | $102.82 |
| J9200 | A | $61.41 |
| J9201 | A | $90.50 |
| J9202 | A | $188.22 |
| J9206 | A | $6.49 |
| J9207 | A | $64.08 |
| J9208 | A | $32.34 |
| J9211 | A | $58.88 |
| J9212 | A | $6.88 |
| J9214 | A | $16.98 |
| J9215 | A | $31.50 |
| J9216 | A | $588.19 |
| J9217 | A | $218.98 |
| J9218 | A | $4.47 |
| J9219 | A | $4,774.35 |
| J9225 | A | $3,853.68 |
| J9226 | A | $15,566.73 |
| J9230 | A | $156.37 |
| J9245 | A | $1,280.08 |
| J9261 | A | $115.08 |
| J9263 | A | $10.05 |
| J9264 | A | $9.42 |
| J9265 | A | $9.43 |
| J9266 | A | $2,701.13 |
| J9268 | A | $1,094.53 |
| J9280 | A | $19.74 |
| J9293 | A | $37.72 |
| J9300 | A | $2,716.72 |
| J9302 | A | $45.41 |
| J9303 | A | $86.41 |
| J9305 | A | $53.26 |
| J9307 | A | $165.63 |
| J9310 | A | $621.14 |
| J9315 | A | $224.79 |
| J9320 | A | $268.24 |
| J9328 | A | $4.85 |
| J9330 | A | $51.06 |
| J9340 | A | $132.44 |
| J9351 | A | $9.94 |
| J9355 | A | $71.76 |
| J9357 | A | $968.29 |
| J9395 | A | $84.44 |
| J9600 | A | $19,143.46 |
| P9041 | A | $20.37 |
| P9045 | A | $67.07 |
| P9046 | A | $29.16 |
| P9047 | A | $70.39 |
| Q0138 | A | $0.66 |
| Q0515 | A | $1.78 |
| Q2017 | A | $319.35 |
| Q2040 | A | $5.53 |
| Q2041 | A | $0.87 |
| Q2042 | A | $2.55 |
| Q2043 | A | $32,860.00 |
| Q2044 | A | $38.61 |
| Q3025 | A | $240.59 |
| Q4101 | A | $36.23 |
| Q4102 | A | $5.79 |
| Q4103 | A | $5.79 |
| Q4104 | A | $16.41 |
| Q4105 | A | $9.72 |
| Q4106 | A | $40.90 |
| Q4107 | A | $95.86 |
| Q4108 | A | $21.94 |
| Q4110 | A | $31.72 |
| Q4111 | A | $6.85 |
| Q4112 | A | $335.44 |
| Q4113 | A | $335.44 |
| Q4114 | A | $1,029.70 |
| Q4115 | A | $8.34 |
| Q4116 | A | $32.03 |
| Q4118 | A | $2.97 |
| Q4119 | A | $4.57 |
| Q4121 | A | $20.77 |
| Q9968 | A | $1.30 |
| 90371 | A | $114.60 |
| 90375 | A | $187.53 |
| 90376 | A | $179.52 |
| 90378 | A | $1,169.99 |
| 90396 | A | $129.48 |
| 90476 | A | $23.24 |
| 90585 | A | $113.31 |
| 90675 | A | $207.46 |
| 90676 | A | $107.83 |
| 90680 | A | $73.07 |
| 90681 | A | $107.63 |
| 90733 | A | $111.82 |
| 90734 | A | $93.82 |
| 90735 | A | $101.12 |
| 90740 | C | $0.00 |
| 90743 | C | $0.00 |
| 90744 | C | $0.00 |
| 90746 | 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.

