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January 7, 2013 - Revised 03.29.13

Revised January 2013 1st Quarter ASC Drug File — Effective 01/01/2013

HCPCS Code Status Indicator Amount
A9584 A $2,010.05
C9121 A $17.85
C9248 A $2.96
C9250 A $39.08
C9257 A $1.59
C9285 A $13.31
C9290 A $1.09
C9292 A $102.33
C9293 A $233.73
C9294 A $30.90
C9295 A $29.29
C9296 A $16.96
C9358 A $11.78
C9360 A $11.88
C9363 A $24.61
C9367 A $4.35
C9399 C $0.00
J0129 A $22.40
J0130 A $577.27
J0131 A $0.12
J0132 A $3.04
J0135 A $484.72
J0152 A $109.01
J0178 A $980.50
J0180 A $140.68
J0205 A $42.03
J0207 A $306.16
J0210 A $42.40
J0215 A $41.64
J0220 A $206.03
J0221 A $153.62
J0256 A $3.95
J0257 A $3.92
J0287 A $11.91
J0288 A $14.00
J0289 A $14.46
J0300 A $152.43
J0348 A $1.16
J0365 A $2.65
J0395 A $86.37
J0475 A $175.88
J0476 A $76.51
J0480 A $2,516.73
J0485 A $3.81
J0490 A $38.27
J0583 A $2.99
J0585 A $5.47
J0586 A $6.90
J0587 A $10.89
J0588 A $4.46
J0594 A $21.92
J0597 A $31.06
J0598 A $47.19
J0600 A $201.40
J0630 A $62.75
J0637 A $12.83
J0638 A $89.54
J0641 A $1.85
J0712 A $0.78
J0716 A $3,635.80
J0718 A $4.89
J0740 A $756.64
J0775 A $37.51
J0795 A $5.82
J0800 A $3,014.33
J0833 A $101.68
J0840 A $2,216.80
J0850 A $1,013.87
J0878 A $0.57
J0881 A $3.45
J0885 A $10.26
J0894 A $34.05
J0897 A $14.27
J0900 A $33.36
J1162 A $899.60
J1190 A $165.93
J1205 A $227.14
J1212 A $86.09
J1290 A $319.61
J1300 A $199.36
J1324 A $0.53
J1327 A $25.06
J1410 A $139.45
J1430 A $299.94
J1435 A $1.54
J1438 A $241.34
J1440 A $275.69
J1441 A $435.92
J1451 A $6.25
J1452 A $85.00
J1453 A $1.73
J1458 A $355.52
J1459 A $35.57
J1460 A $23.76
J1557 A $36.59
J1559 A $7.29
J1560 A $237.62
J1561 A $38.23
J1562 A $12.72
J1566 A $34.74
J1568 A $31.60
J1569 A $37.64
J1570 A $72.47
J1571 A $52.01
J1572 A $34.95
J1573 A $52.01
J1590 A $86.33
J1595 A $130.44
J1610 A $118.18
J1620 A $6.06
J1640 A $13.32
J1670 A $278.27
J1725 A $2.65
J1730 A $88.27
J1740 A $151.51
J1742 A $114.39
J1743 A $455.03
J1744 A $234.87
J1745 A $66.41
J1750 A $11.97
J1786 A $41.86
J1830 A $251.48
J1835 A $0.28
J1930 A $34.97
J1931 A $28.20
J1945 A $570.54
J1950 A $672.89
J2020 A $38.95
J2212 A $0.38
J2248 A $0.94
J2265 A $0.58
J2278 A $6.62
J2315 A $2.84
J2323 A $12.30
J2325 A $54.32
J2353 A $129.66
J2355 A $262.88
J2357 A $23.54
J2358 A $2.75
J2425 A $12.97
J2426 A $7.24
J2469 A $18.98
J2503 A $1,029.33
J2504 A $267.83
J2505 A $2,921.12
J2507 A $356.54
J2562 A $291.39
J2597 A $5.63
J2700 A $2.26
J2724 A $13.50
J2725 A $29.74
J2730 A $89.99
J2770 A $187.32
J2778 A $398.01
J2783 A $208.19
J2785 A $53.64
J2788 A $24.54
J2790 A $84.45
J2791 A $5.07
J2792 A $18.33
J2793 A $24.09
J2794 A $5.64
J2796 A $49.32
J2820 A $29.69
J2850 A $27.49
J2941 A $65.03
J2993 A $2,301.90
J2997 A $51.91
J3095 A $2.65
J3101 A $70.77
J3240 A $1,051.90
J3243 A $1.68
J3246 A $7.90
J3262 A $3.56
J3285 A $61.24
J3300 A $3.78
J3315 A $175.79
J3355 A $66.48
J3357 A $134.00
J3365 A $457.73
J3385 A $348.86
J3396 A $10.28
J3465 A $4.92
J3487 A $222.60
J3488 A $224.70
J7178 A $0.92
J7180 A $6.42
J7183 A $0.93
J7185 A $1.10
J7186 A $0.94
J7187 A $0.90
J7189 A $1.61
J7190 A $0.92
J7192 A $1.13
J7193 A $0.96
J7194 A $1.06
J7195 A $1.25
J7196 A $103.35
J7197 A $3.04
J7198 A $1.63
J7308 A $160.72
J7309 A $83.69
J7310 A $16,960.00
J7311 A $19,345.00
J7312 A $195.86
J7321 A $89.98
J7323 A $151.34
J7324 A $167.46
J7325 A $12.06
J7326 A $606.63
J7335 A $25.55
J7501 A $161.37
J7504 A $671.43
J7505 A $1,156.08
J7511 A $538.68
J7513 A $526.34
J7525 A $138.89
J7527 A $6.18
J8501 A $6.48
J8510 A $5.56
J8520 A $8.87
J8521 A $29.51
J8560 A $52.36
J8562 A $81.77
J8650 A $25.78
J8700 A $10.67
J8705 A $84.22
J9002 A $539.08
J9010 A $611.45
J9015 A $1,246.98
J9017 A $45.13
J9019 A $334.32
J9020 A $63.20
J9025 A $5.53
J9027 A $126.25
J9031 A $120.87
J9033 A $20.62
J9035 A $63.45
J9041 A $44.31
J9042 A $98.99
J9043 A $137.82
J9050 A $175.75
J9055 A $51.80
J9065 A $29.17
J9070 A $23.37
J9098 A $528.75
J9120 A $577.60
J9150 A $22.05
J9151 A $243.80
J9155 A $2.86
J9160 A $1,646.18
J9171 A $6.37
J9178 A $1.58
J9179 A $95.54
J9185 A $86.66
J9200 A $65.32
J9201 A $10.86
J9202 A $178.39
J9207 A $66.43
J9208 A $29.16
J9211 A $97.96
J9212 A $17.06
J9214 A $19.29
J9216 A $2,517.90
J9217 A $215.13
J9218 A $7.46
J9219 A $4,819.82
J9225 A $2,981.05
J9226 A $16,177.64
J9228 A $125.17
J9230 A $157.86
J9245 A $1,314.21
J9261 A $123.40
J9263 A $3.95
J9264 A $9.52
J9266 A $5,890.00
J9268 A $1,290.39
J9280 A $24.04
J9293 A $36.88
J9300 A $2,742.59
J9302 A $45.42
J9303 A $89.20
J9305 A $58.06
J9307 A $182.65
J9310 A $660.78
J9315 A $242.28
J9320 A $271.16
J9328 A $4.83
J9330 A $56.14
J9340 A $175.48
J9351 A $3.17
J9355 A $76.54
J9357 A $1,038.99
J9395 A $88.34
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 $321.94
Q2043 A $32,560.45
Q2049 A $498.26
Q3025 A $291.64
Q4101 A $39.47
Q4102 A $8.08
Q4103 A $8.08
Q4104 A $18.71
Q4105 A $13.76
Q4106 A $42.55
Q4107 A $99.17
Q4108 A $25.22
Q4110 A $34.21
Q4111 A $7.02
Q4112 A $394.62
Q4113 A $394.62
Q4114 A $1,198.51
Q4115 A $8.13
Q4116 A $32.37
Q4118 A $2.85
Q4119 A $4.58
Q4121 A $22.12
Q4122 A $86.57
Q4123 A $14.04
Q4124 A $11.13
Q4125 A $114.05
Q4128 A $31.93
Q4129 A $31.26
Q4131 A $153.25
Q4132 A $129.26
Q4133 A $123.95
Q9968 A $1.20
90371 A $104.73
90375 A $206.47
90376 A $197.46
90378 A $1,313.55
90396 A $79.88
90581 A $112.86
90585 A $120.87
90675 A $190.40
90676 A $155.64
90681 A $102.50
90733 A $106.49
90734 A $98.98
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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