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Revised April 2013 2nd QTR ASC Drug File

Effective 04/01/2013

HCPCS Code Status Indicator Amount
A9584 A $1,990.08
C9121 A $17.12
C9130 A $63.58
C9248 A $2.87
C9250 A $100.31
C9257 A $1.59
C9285 A $13.28
C9290 A $1.08
C9292 A $102.27
C9293 A $233.73
C9294 A $30.90
C9295 A $29.29
C9296 A $15.57
C9297 A $2.53
C9298 A $1,046.75
C9358 A $11.89
C9360 A $12.00
C9363 A $27.54
C9399 C $0.00
J0129 A $22.62
J0130 A $574.85
J0131 A $0.13
J0132 A $3.20
J0135 A $490.56
J0152 A $109.55
J0178 A $980.50
J0180 A $140.85
J0205 A $42.03
J0207 A $312.76
J0210 A $42.40
J0215 A $41.64
J0220 A $205.87
J0221 A $153.62
J0256 A $3.92
J0257 A $3.93
J0287 A $11.28
J0288 A $14.00
J0289 A $15.23
J0300 A $152.43
J0348 A $1.04
J0365 A $2.65
J0395 A $86.37
J0475 A $175.16
J0476 A $75.91
J0480 A $2,321.25
J0485 A $3.81
J0490 A $38.29
J0583 A $2.99
J0585 A $5.46
J0586 A $6.89
J0587 A $10.82
J0588 A $4.45
J0594 A $21.92
J0597 A $31.14
J0598 A $47.26
J0600 A $201.40
J0630 A $62.79
J0637 A $13.08
J0638 A $90.24
J0641 A $1.82
J0712 A $0.82
J0716 A $3,667.49
J0718 A $5.15
J0740 A $757.16
J0775 A $37.51
J0795 A $5.82
J0800 A $3,012.76
J0833 A $101.68
J0840 A $2,220.92
J0850 A $1,013.87
J0878 A $0.57
J0881 A $3.33
J0885 A $10.39
J0894 A $34.09
J0897 A $14.22
J0900 A $33.36
J1162 A $1,045.83
J1190 A $153.07
J1205 A $205.85
J1212 A $84.20
J1290 A $317.14
J1300 A $201.12
J1324 A $0.55
J1327 A $25.95
J1410 A $136.72
J1430 A $299.94
J1435 A $1.54
J1438 A $241.21
J1440 A $277.25
J1441 A $439.90
J1451 A $6.23
J1452 A $85.00
J1453 A $1.72
J1458 A $355.39
J1459 A $36.08
J1460 A $23.86
J1557 A $37.22
J1559 A $7.29
J1560 A $238.62
J1561 A $38.23
J1562 A $12.72
J1566 A $33.12
J1568 A $31.50
J1569 A $37.83
J1570 A $64.49
J1571 A $52.01
J1572 A $35.52
J1573 A $52.01
J1590 A $86.33
J1595 A $136.50
J1610 A $115.04
J1620 A $6.06
J1640 A $13.27
J1670 A $276.72
J1725 A $2.71
J1730 A $88.27
J1740 A $151.50
J1742 A $164.73
J1743 A $470.35
J1744 A $234.77
J1745 A $67.68
J1750 A $12.15
J1786 A $41.87
J1830 A $258.23
J1835 A $0.28
J1930 A $35.65
J1931 A $28.21
J1945 A $570.54
J1950 A $680.67
J2020 A $39.10
J2212 A $0.38
J2248 A $0.95
J2265 A $0.58
J2278 A $6.61
J2315 A $2.83
J2323 A $12.29
J2325 A $54.68
J2353 A $131.13
J2355 A $256.80
J2357 A $24.47
J2358 A $2.75
J2425 A $13.26
J2426 A $7.23
J2469 A $19.45
J2503 A $1,030.43
J2504 A $267.83
J2505 A $2,940.20
J2507 A $365.79
J2562 A $292.60
J2597 A $5.60
J2700 A $2.25
J2724 A $13.75
J2725 A $29.74
J2730 A $89.52
J2770 A $188.54
J2778 A $397.72
J2783 A $208.17
J2785 A $53.63
J2788 A $24.97
J2790 A $58.46
J2791 A $4.78
J2792 A $18.59
J2793 A $24.09
J2794 A $5.62
J2796 A $49.84
J2820 A $26.90
J2850 A $27.49
J2941 A $63.75
J2993 A $2,301.90
J2997 A $52.19
J3095 A $2.66
J3101 A $72.44
J3240 A $1,053.98
J3243 A $1.61
J3246 A $8.20
J3262 A $3.69
J3285 A $61.24
J3300 A $3.67
J3315 A $172.30
J3355 A $65.06
J3357 A $134.19
J3365 A $457.73
J3385 A $348.63
J3396 A $10.30
J3465 A $4.87
J3487 A $220.95
J3488 A $224.68
J7178 A $0.92
J7180 A $6.42
J7183 A $0.93
J7185 A $1.06
J7186 A $0.93
J7187 A $0.90
J7189 A $1.62
J7190 A $0.91
J7192 A $1.13
J7193 A $0.95
J7194 A $1.09
J7195 A $1.26
J7196 A $103.35
J7197 A $3.04
J7198 A $1.64
J7308 A $160.03
J7309 A $78.68
J7310 A $16,960.00
J7311 A $19,345.00
J7312 A $195.92
J7315 A $380.54
J7321 A $88.84
J7323 A $163.96
J7324 A $167.50
J7325 A $12.20
J7326 A $580.13
J7335 A $25.55
J7501 A $162.95
J7504 A $705.82
J7505 A $1,156.08
J7511 A $529.73
J7513 A $526.34
J7525 A $138.00
J7527 A $6.18
J8501 A $6.48
J8510 A $6.57
J8520 A $8.92
J8521 A $29.67
J8560 A $52.29
J8562 A $81.77
J8650 A $27.07
J8700 A $11.19
J8705 A $86.58
J9002 A $543.06
J9010 A $623.63
J9015 A $1,246.98
J9017 A $45.07
J9019 A $334.32
J9020 A $63.21
J9025 A $5.72
J9027 A $126.32
J9031 A $117.45
J9033 A $20.62
J9035 A $63.56
J9041 A $44.31
J9042 A $98.77
J9043 A $140.58
J9050 A $175.81
J9055 A $51.81
J9065 A $26.67
J9070 A $35.42
J9098 A $528.75
J9120 A $592.43
J9150 A $26.08
J9151 A $243.80
J9155 A $2.87
J9160 A $1,646.18
J9171 A $6.15
J9178 A $1.41
J9179 A $95.56
J9185 A $83.74
J9200 A $57.68
J9201 A $8.04
J9202 A $193.19
J9207 A $67.59
J9208 A $29.83
J9211 A $62.71
J9212 A $17.06
J9214 A $17.39
J9216 A $2,517.90
J9217 A $207.81
J9218 A $8.87
J9219 A $4,819.82
J9225 A $2,951.87
J9226 A $16,417.13
J9228 A $126.96
J9230 A $154.70
J9245 A $1,301.51
J9261 A $127.02
J9263 A $1.06
J9264 A $9.54
J9266 A $5,890.00
J9268 A $1,390.65
J9280 A $22.25
J9293 A $37.32
J9300 A $2,742.59
J9302 A $45.33
J9303 A $89.25
J9305 A $57.96
J9307 A $182.60
J9310 A $677.94
J9315 A $242.17
J9320 A $273.31
J9328 A $4.83
J9330 A $54.84
J9340 A $265.00
J9351 A $2.35
J9355 A $78.55
J9357 A $1,038.42
J9395 A $88.33
J9600 A $19,325.78
P9041 A $22.63
P9045 A $60.67
P9046 A $30.24
P9047 A $69.20
Q0138 A $0.64
Q0515 A $1.80
Q2017 A $321.86
Q2043 A $32,769.42
Q2049 A $498.26
Q3025 A $305.42
Q4101 A $39.58
Q4102 A $8.21
Q4103 A $8.21
Q4104 A $19.10
Q4105 A $13.41
Q4106 A $42.55
Q4107 A $97.68
Q4108 A $24.13
Q4110 A $33.80
Q4111 A $7.01
Q4112 A $355.51
Q4113 A $355.51
Q4114 A $1,175.89
Q4115 A $7.61
Q4116 A $31.69
Q4118 A $2.83
Q4119 A $4.43
Q4121 A $21.93
Q4122 A $70.00
Q4123 A $16.16
Q4124 A $11.37
Q4125 A $115.67
Q4127 A $13.78
Q4128 A $32.34
Q4131 A $162.82
Q4132 A $163.68
Q4133 A $120.51
Q9968 A $2.06
90371 A $112.11
90375 A $206.53
90376 A $202.72
90378 A $1,240.19
90396 A $79.88
90581 A $94.05
90585 A $117.45
90675 A $221.98
90676 A $155.64
90681 A $102.50
90733 A $106.49
90734 A $88.87
90735 A $102.08
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 2012 by the American Medical Association.

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