Revised October 2013 4th QTR ASC Drug File
Revised: 07.01.14
Effective 10/01/2013
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9584 | A | $2,380.64 |
| C1204 | A | $223.15 |
| C9121 | A | $18.15 |
| C9130 | A | $38.56 |
| C9131 | A | $29.22 |
| C9132 | A | $1.92 |
| C9248 | A | $2.82 |
| C9250 | A | $26.15 |
| C9257 | A | $1.62 |
| C9285 | A | $13.20 |
| C9290 | A | $1.10 |
| C9292 | A | $102.11 |
| C9293 | A | $244.96 |
| C9294 | A | $31.12 |
| C9295 | A | $29.29 |
| C9296 | A | $10.83 |
| C9297 | A | $2.48 |
| C9298 | A | $1,046.75 |
| C9358 | A | $12.43 |
| C9360 | A | $12.10 |
| C9363 | A | $29.83 |
| C9399 | C | $0.00 |
| J0129 | A | $23.06 |
| J0130 | A | $651.25 |
| J0131 | A | $0.13 |
| J0132 | A | $2.65 |
| J0135 | A | $515.89 |
| J0152 | A | $109.38 |
| J0178 | A | $980.50 |
| J0180 | A | $146.19 |
| J0205 | A | $42.03 |
| J0207 | A | $298.54 |
| J0210 | A | $42.40 |
| J0215 | A | $41.64 |
| J0220 | A | $206.64 |
| J0221 | A | $153.60 |
| J0256 | A | $4.02 |
| J0257 | A | $3.99 |
| J0287 | A | $11.42 |
| J0288 | A | $14.00 |
| J0289 | A | $15.57 |
| J0300 | A | $152.43 |
| J0348 | A | $0.85 |
| J0365 | A | $2.65 |
| J0395 | A | $86.37 |
| J0475 | A | $160.30 |
| J0476 | A | $74.11 |
| J0480 | A | $2,442.92 |
| J0485 | A | $3.80 |
| J0490 | A | $38.25 |
| J0583 | A | $3.21 |
| J0585 | A | $5.45 |
| J0586 | A | $7.05 |
| J0587 | A | $10.89 |
| J0588 | A | $4.48 |
| J0594 | A | $25.18 |
| J0597 | A | $32.69 |
| J0598 | A | $49.34 |
| J0600 | A | $201.40 |
| J0630 | A | $69.05 |
| J0637 | A | $13.35 |
| J0638 | A | $91.02 |
| J0641 | A | $1.74 |
| J0712 | A | $0.88 |
| J0716 | A | $3,672.34 |
| J0718 | A | $5.18 |
| J0740 | A | $648.43 |
| J0775 | A | $38.57 |
| J0795 | A | $7.78 |
| J0800 | A | $3,050.44 |
| J0833 | A | $101.68 |
| J0840 | A | $2,349.90 |
| J0850 | A | $1,013.87 |
| J0878 | A | $0.60 |
| J0881 | A | $3.61 |
| J0885 | A | $11.22 |
| J0894 | A | $34.78 |
| J0897 | A | $14.15 |
| J0900 | A | $33.36 |
| J1162 | A | $1,241.37 |
| J1190 | A | $139.65 |
| J1205 | A | $163.98 |
| J1212 | A | $79.32 |
| J1290 | A | $355.64 |
| J1300 | A | $201.12 |
| J1324 | A | $0.55 |
| J1327 | A | $28.08 |
| J1410 | A | $149.57 |
| J1430 | A | $299.94 |
| J1435 | A | $1.54 |
| J1438 | A | $255.10 |
| J1440 | A | $288.69 |
| J1441 | A | $458.51 |
| J1451 | A | $7.17 |
| J1452 | A | $85.00 |
| J1453 | A | $1.72 |
| J1458 | A | $359.70 |
| J1459 | A | $36.52 |
| J1460 | A | $23.98 |
| J1557 | A | $36.78 |
| J1559 | A | $7.65 |
| J1560 | A | $239.77 |
| J1561 | A | $40.47 |
| J1562 | A | $12.72 |
| J1566 | A | $35.75 |
| J1568 | A | $31.49 |
| J1569 | A | $39.27 |
| J1570 | A | $73.71 |
| J1571 | A | $51.03 |
| J1572 | A | $36.08 |
| J1573 | A | $51.03 |
| J1590 | A | $86.33 |
| J1595 | A | $151.47 |
| J1610 | A | $127.98 |
| J1620 | A | $6.06 |
| J1640 | A | $16.59 |
| J1670 | A | $272.52 |
| J1725 | A | $2.70 |
| J1730 | A | $88.27 |
| J1740 | A | $155.25 |
| J1742 | A | $78.93 |
| J1743 | A | $469.12 |
| J1744 | A | $254.73 |
| J1745 | A | $69.96 |
| J1750 | A | $12.13 |
| J1786 | A | $42.01 |
| J1830 | A | $282.70 |
| J1835 | A | $0.28 |
| J1930 | A | $37.16 |
| J1931 | A | $28.31 |
| J1945 | A | $570.54 |
| J1950 | A | $747.92 |
| J2020 | A | $39.71 |
| J2212 | A | $0.45 |
| J2248 | A | $0.95 |
| J2265 | A | $0.58 |
| J2278 | A | $6.60 |
| J2315 | A | $2.80 |
| J2323 | A | $12.99 |
| J2325 | A | $60.26 |
| J2353 | A | $136.14 |
| J2355 | A | $276.60 |
| J2357 | A | $25.52 |
| J2358 | A | $2.75 |
| J2425 | A | $14.37 |
| J2426 | A | $7.43 |
| J2469 | A | $19.38 |
| J2503 | A | $1,026.70 |
| J2504 | A | $275.88 |
| J2505 | A | $3,120.23 |
| J2507 | A | $508.89 |
| J2562 | A | $297.65 |
| J2597 | A | $5.63 |
| J2700 | A | $2.19 |
| J2724 | A | $14.26 |
| J2725 | A | $29.74 |
| J2730 | A | $88.93 |
| J2770 | A | $194.32 |
| J2778 | A | $397.26 |
| J2783 | A | $211.35 |
| J2785 | A | $53.43 |
| J2788 | A | $25.15 |
| J2790 | A | $82.69 |
| J2791 | A | $4.78 |
| J2792 | A | $18.67 |
| J2793 | A | $24.09 |
| J2794 | A | $5.78 |
| J2796 | A | $51.12 |
| J2820 | A | $28.59 |
| J2850 | A | $27.49 |
| J2941 | A | $69.13 |
| J2993 | A | $2,301.91 |
| J2997 | A | $56.01 |
| J3095 | A | $2.65 |
| J3101 | A | $78.99 |
| J3240 | A | $1,212.34 |
| J3243 | A | $1.77 |
| J3246 | A | $8.95 |
| J3262 | A | $3.70 |
| J3285 | A | $61.24 |
| J3300 | A | $3.96 |
| J3315 | A | $199.09 |
| J3355 | A | $67.37 |
| J3357 | A | $142.17 |
| J3365 | A | $457.73 |
| J3385 | A | $348.35 |
| J3396 | A | $10.45 |
| J3465 | A | $4.49 |
| J7178 | A | $0.93 |
| J7180 | A | $6.51 |
| J7183 | A | $0.91 |
| J7185 | A | $1.14 |
| J7186 | A | $0.93 |
| J7187 | A | $0.90 |
| J7189 | A | $1.65 |
| J7190 | A | $0.92 |
| J7192 | A | $1.13 |
| J7193 | A | $0.95 |
| J7194 | A | $1.10 |
| J7195 | A | $1.38 |
| J7196 | A | $103.35 |
| J7197 | A | $3.11 |
| J7198 | A | $1.64 |
| J7308 | A | $172.60 |
| J7309 | A | $83.69 |
| J7310 | A | $16,960.00 |
| J7311 | A | $19,345.00 |
| J7312 | A | $195.91 |
| J7315 | A | $379.48 |
| J7321 | A | $88.85 |
| J7323 | A | $153.41 |
| J7324 | A | $177.16 |
| J7325 | A | $12.83 |
| J7326 | A | $613.28 |
| J7335 | A | $25.55 |
| J7501 | A | $83.13 |
| J7504 | A | $721.06 |
| J7505 | A | $1,156.08 |
| J7511 | A | $569.53 |
| J7513 | A | $526.34 |
| J7525 | A | $136.89 |
| J7527 | A | $6.48 |
| J8501 | A | $6.69 |
| J8510 | A | $11.03 |
| J8520 | A | $9.69 |
| J8521 | A | $32.19 |
| J8560 | A | $55.68 |
| J8562 | A | $81.77 |
| J8650 | A | $27.07 |
| J8700 | A | $11.56 |
| J8705 | A | $89.13 |
| J9010 | A | $623.63 |
| J9015 | A | $1,423.64 |
| J9017 | A | $49.40 |
| J9019 | A | $344.38 |
| J9020 | A | $64.57 |
| J9025 | A | $5.74 |
| J9027 | A | $129.53 |
| J9031 | A | $120.91 |
| J9033 | A | $21.06 |
| J9035 | A | $64.62 |
| J9041 | A | $44.89 |
| J9042 | A | $102.65 |
| J9043 | A | $139.11 |
| J9050 | A | $870.93 |
| J9055 | A | $52.56 |
| J9065 | A | $23.99 |
| J9070 | A | $39.67 |
| J9098 | A | $544.54 |
| J9120 | A | $645.75 |
| J9150 | A | $30.02 |
| J9151 | A | $243.80 |
| J9155 | A | $3.72 |
| J9160 | A | $1,646.18 |
| J9171 | A | $4.63 |
| J9178 | A | $1.18 |
| J9179 | A | $98.43 |
| J9185 | A | $84.17 |
| J9200 | A | $67.08 |
| J9201 | A | $7.96 |
| J9202 | A | $194.19 |
| J9207 | A | $68.65 |
| J9208 | A | $31.04 |
| J9211 | A | $35.31 |
| J9212 | A | $17.06 |
| J9214 | A | $20.70 |
| J9216 | A | $2,517.90 |
| J9217 | A | $202.84 |
| J9218 | A | $10.25 |
| J9219 | A | $4,819.82 |
| J9225 | A | $2,966.80 |
| J9226 | A | $16,660.71 |
| J9228 | A | $128.96 |
| J9230 | A | $154.70 |
| J9245 | A | $1,293.55 |
| J9261 | A | $130.63 |
| J9263 | A | $0.54 |
| J9264 | A | $9.55 |
| J9266 | A | $6,007.38 |
| J9268 | A | $1,419.70 |
| J9280 | A | $24.54 |
| J9293 | A | $34.62 |
| J9300 | A | $2,742.59 |
| J9302 | A | $46.53 |
| J9303 | A | $91.38 |
| J9305 | A | $59.49 |
| J9307 | A | $182.61 |
| J9310 | A | $678.70 |
| J9315 | A | $251.94 |
| J9320 | A | $274.35 |
| J9328 | A | $5.03 |
| J9330 | A | $55.97 |
| J9340 | A | $630.70 |
| J9351 | A | $2.20 |
| J9355 | A | $78.72 |
| J9357 | A | $1,052.98 |
| J9395 | A | $89.68 |
| J9600 | A | $19,325.78 |
| P9041 | A | $22.63 |
| P9045 | A | $60.67 |
| P9046 | A | $30.24 |
| P9047 | A | $69.20 |
| Q0138 | A | $0.68 |
| Q0515 | A | $1.80 |
| Q2017 | A | $332.62 |
| Q2043 | A | $32,709.98 |
| Q2049 | A | $498.26 |
| Q2050 | A | $545.48 |
| Q2051 | A | $150.33 |
| Q3025 | A | $307.14 |
| Q4101 | A | $41.06 |
| Q4102 | A | $9.51 |
| Q4103 | A | $9.51 |
| Q4104 | A | $25.75 |
| Q4105 | A | $13.14 |
| Q4106 | A | $44.43 |
| Q4107 | A | $98.50 |
| Q4108 | A | $28.46 |
| Q4110 | A | $38.59 |
| Q4111 | A | $6.91 |
| Q4112 | A | $392.70 |
| Q4113 | A | $392.70 |
| Q4114 | A | $1,235.31 |
| Q4115 | A | $12.68 |
| Q4116 | A | $32.89 |
| Q4118 | A | $2.62 |
| Q4119 | A | $4.28 |
| Q4121 | A | $23.21 |
| Q4122 | A | $77.80 |
| Q4123 | A | $15.45 |
| Q4124 | A | $11.89 |
| Q4125 | A | $114.31 |
| Q4126 | A | $57.99 |
| Q4127 | A | $13.78 |
| Q4128 | A | $34.08 |
| Q4131 | A | $214.09 |
| Q4132 | A | $128.70 |
| Q4133 | A | $147.84 |
| Q4134 | A | $31.48 |
| Q4135 | A | $0.16 |
| Q4136 | A | $0.15 |
| Q9968 | A | $1.91 |
| 90371 | A | $112.03 |
| 90375 | A | $219.82 |
| 90376 | A | $216.54 |
| 90378 | A | $1,240.19 |
| 90396 | A | $675.22 |
| 90581 | A | $94.05 |
| 90585 | A | $120.91 |
| 90675 | A | $232.39 |
| 90676 | A | $155.64 |
| 90681 | A | $108.65 |
| 90733 | A | $106.49 |
| 90734 | A | $92.22 |
| 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 2014 by the American Medical Association.

