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Revised July 2013 3rd QTR ASC Drug File

Effective 07/01/2013

HCPCS Code Status Indicator Amount
A9584 A $2,335.62
C9121 A $18.07
C9130 A $63.58
C9131 A $29.40
C9248 A $2.83
C9250 A $33.91
C9257 A $1.62
C9285 A $13.17
C9290 A $1.08
C9292 A $102.09
C9293 A $233.73
C9294 A $30.90
C9295 A $29.29
C9296 A $11.10
C9297 A $2.48
C9298 A $1,046.75
C9358 A $11.96
C9360 A $12.04
C9363 A $29.17
C9399 C $0.00
J0129 A $22.84
J0130 A $629.40
J0131 A $0.13
J0132 A $3.08
J0135 A $526.39
J0152 A $109.14
J0178 A $980.50
J0180 A $145.71
J0205 A $42.03
J0207 A $295.95
J0210 A $42.40
J0215 A $41.64
J0220 A $206.09
J0221 A $153.62
J0256 A $3.99
J0257 A $4.03
J0287 A $11.41
J0288 A $14.00
J0289 A $14.87
J0300 A $152.43
J0348 A $0.66
J0365 A $2.65
J0395 A $86.37
J0475 A $173.97
J0476 A $75.19
J0480 A $2,431.61
J0485 A $3.80
J0490 A $38.23
J0583 A $3.21
J0585 A $5.47
J0586 A $6.96
J0587 A $10.82
J0588 A $4.48
J0594 A $24.80
J0597 A $31.14
J0598 A $48.68
J0600 A $201.40
J0630 A $68.54
J0637 A $12.79
J0638 A $90.94
J0641 A $1.79
J0712 A $0.82
J0716 A $3,635.80
J0718 A $5.01
J0740 A $686.11
J0775 A $38.69
J0795 A $7.10
J0800 A $3,013.54
J0833 A $101.68
J0840 A $2,216.80
J0850 A $1,013.88
J0878 A $0.61
J0881 A $3.46
J0885 A $10.97
J0894 A $34.54
J0897 A $14.16
J0900 A $33.36
J1162 A $1,090.96
J1190 A $153.02
J1205 A $177.23
J1212 A $82.02
J1290 A $316.55
J1300 A $201.12
J1324 A $0.55
J1327 A $26.12
J1410 A $148.88
J1430 A $299.94
J1435 A $1.54
J1438 A $253.48
J1440 A $285.39
J1441 A $452.26
J1451 A $6.46
J1452 A $85.00
J1453 A $1.72
J1458 A $357.31
J1459 A $36.60
J1460 A $23.81
J1557 A $36.94
J1559 A $7.29
J1560 A $238.08
J1561 A $38.97
J1562 A $12.72
J1566 A $30.66
J1568 A $31.57
J1569 A $39.17
J1570 A $72.65
J1571 A $51.73
J1572 A $35.95
J1573 A $51.73
J1590 A $86.33
J1595 A $149.96
J1610 A $122.27
J1620 A $6.06
J1640 A $15.65
J1670 A $363.88
J1725 A $2.71
J1730 A $88.27
J1740 A $154.66
J1742 A $133.57
J1743 A $468.97
J1744 A $254.72
J1745 A $67.96
J1750 A $12.12
J1786 A $41.94
J1830 A $279.71
J1835 A $0.28
J1930 A $36.45
J1931 A $28.27
J1945 A $570.54
J1950 A $744.73
J2020 A $40.93
J2212 A $0.40
J2248 A $0.94
J2265 A $0.58
J2278 A $6.61
J2315 A $2.83
J2323 A $13.08
J2325 A $59.72
J2353 A $134.64
J2355 A $277.71
J2357 A $24.47
J2358 A $2.75
J2425 A $13.26
J2426 A $7.42
J2469 A $18.93
J2503 A $1,027.30
J2504 A $275.88
J2505 A $3,013.87
J2507 A $423.06
J2562 A $296.66
J2597 A $5.64
J2700 A $2.15
J2724 A $14.32
J2725 A $29.74
J2730 A $90.16
J2770 A $200.41
J2778 A $397.51
J2783 A $210.96
J2785 A $53.48
J2788 A $26.58
J2790 A $92.00
J2791 A $4.76
J2792 A $18.31
J2793 A $24.09
J2794 A $5.77
J2796 A $50.93
J2820 A $28.60
J2850 A $27.49
J2941 A $70.38
J2993 A $2,171.61
J2997 A $56.35
J3095 A $2.65
J3101 A $74.97
J3240 A $1,053.26
J3243 A $1.76
J3246 A $8.03
J3262 A $3.70
J3285 A $61.24
J3300 A $3.91
J3315 A $192.43
J3355 A $64.42
J3357 A $138.29
J3365 A $457.73
J3385 A $348.64
J3396 A $10.43
J3465 A $4.65
J7178 A $0.92
J7180 A $6.42
J7183 A $0.91
J7185 A $1.11
J7186 A $0.94
J7187 A $0.91
J7189 A $1.66
J7190 A $0.93
J7192 A $1.13
J7193 A $0.97
J7194 A $1.10
J7195 A $1.33
J7196 A $103.35
J7197 A $3.05
J7198 A $1.64
J7308 A $173.99
J7309 A $83.69
J7310 A $16,960.00
J7311 A $19,345.00
J7312 A $195.89
J7315 A $379.24
J7321 A $85.13
J7323 A $152.88
J7324 A $172.20
J7325 A $12.57
J7326 A $620.10
J7335 A $25.55
J7501 A $186.28
J7504 A $725.00
J7505 A $1,156.08
J7511 A $578.93
J7513 A $526.34
J7525 A $137.57
J7527 A $6.46
J8501 A $6.68
J8510 A $11.00
J8520 A $9.59
J8521 A $31.90
J8560 A $55.12
J8562 A $81.77
J8650 A $27.07
J8700 A $11.22
J8705 A $86.64
J9010 A $623.63
J9015 A $1,492.41
J9017 A $47.41
J9019 A $342.74
J9020 A $64.56
J9025 A $5.77
J9027 A $129.21
J9031 A $119.30
J9033 A $20.82
J9035 A $64.64
J9041 A $45.33
J9042 A $102.74
J9043 A $139.73
J9050 A $175.30
J9055 A $52.48
J9065 A $25.98
J9070 A $40.38
J9098 A $544.23
J9120 A $618.79
J9150 A $28.73
J9151 A $243.80
J9155 A $3.05
J9160 A $1,646.18
J9171 A $4.76
J9178 A $1.34
J9179 A $97.92
J9185 A $88.53
J9200 A $64.13
J9201 A $5.67
J9202 A $189.54
J9207 A $67.66
J9208 A $30.27
J9211 A $43.76
J9212 A $17.06
J9214 A $18.80
J9216 A $2,517.90
J9217 A $206.01
J9218 A $10.50
J9219 A $4,819.82
J9225 A $2,994.41
J9226 A $16,424.13
J9228 A $127.05
J9230 A $157.61
J9245 A $1,273.10
J9261 A $127.28
J9263 A $0.88
J9264 A $9.54
J9266 A $6,004.74
J9268 A $1,399.29
J9280 A $23.99
J9293 A $37.17
J9300 A $2,742.59
J9302 A $46.50
J9303 A $91.10
J9305 A $59.48
J9307 A $182.58
J9310 A $678.87
J9315 A $253.47
J9320 A $276.05
J9328 A $4.84
J9330 A $55.95
J9340 A $265.00
J9351 A $2.13
J9355 A $78.70
J9357 A $1,054.48
J9395 A $89.62
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 $321.05
Q2043 A $32,844.60
Q2049 A $498.26
Q2050 A $545.44
Q2051 A $196.42
Q3025 A $311.31
Q4101 A $41.02
Q4102 A $8.17
Q4103 A $8.17
Q4104 A $22.79
Q4105 A $13.88
Q4106 A $44.48
Q4107 A $100.98
Q4108 A $28.56
Q4110 A $39.54
Q4111 A $6.95
Q4112 A $350.58
Q4113 A $350.58
Q4114 A $1,253.89
Q4115 A $8.98
Q4116 A $32.20
Q4118 A $2.80
Q4119 A $12.75
Q4121 A $23.35
Q4122 A $74.90
Q4123 A $15.76
Q4124 A $11.28
Q4125 A $117.05
Q4126 A $54.22
Q4127 A $13.78
Q4128 A $31.98
Q4131 A $200.74
Q4132 A $129.85
Q4133 A $127.06
Q4134 A $35.45
Q9968 A $1.43
90371 A $101.00
90375 A $215.65
90376 A $213.03
90378 A $1,240.19
90396 A $79.88
90581 A $94.05
90585 A $119.30
90675 A $203.43
90676 A $155.64
90681 A $102.50
90733 A $106.49
90734 A $120.07
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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