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Revised January 2014 1st QTR ASC Drug File

Revised: 10.01.14

Effective 01.01.2014

HCPCS Code Status Indicator Amount
A9520 A $240.00
C9121 A $17.95
C9132 A $1.54
C9133 A $1.27
C9250 A $42.87
C9257 A $1.64
C9290 A $1.10
C9293 A $245.42
C9399 C $0.00
C9441 A $1.06
C9497 A $153.70
J0129 A $23.43
J0130 A $683.49
J0132 A $2.64
J0135 A $569.27
J0178 A $980.50
J0180 A $146.19
J0207 A $300.68
J0215 A $41.64
J0220 A $206.63
J0221 A $153.60
J0256 A $4.03
J0257 A $4.01
J0287 A $10.47
J0289 A $16.19
J0300 A $179.87
J0365 A $3.42
J0401 A $3.77
J0475 A $166.51
J0476 A $75.84
J0480 A $2,468.61
J0485 A $3.80
J0490 A $38.80
J0583 A $3.21
J0585 A $5.44
J0586 A $7.52
J0587 A $11.19
J0588 A $4.48
J0594 A $25.57
J0597 A $32.70
J0598 A $49.22
J0600 A $201.40
J0630 A $69.08
J0637 A $12.77
J0638 A $91.01
J0641 A $1.75
J0716 A $3,654.57
J0717 A $5.13
J0740 A $653.19
J0775 A $38.49
J0795 A $7.77
J0800 A $3,165.52
J0833 A $101.68
J0840 A $2,364.72
J0850 A $1,013.87
J0878 A $0.64
J0881 A $3.68
J0885 A $11.38
J0894 A $32.24
J0897 A $14.29
J1162 A $1,252.95
J1190 A $135.72
J1205 A $151.74
J1290 A $355.44
J1300 A $204.62
J1324 A $0.55
J1327 A $27.74
J1410 A $163.16
J1430 A $299.94
J1438 A $267.93
J1442 A $0.99
J1446 A $4.22
J1451 A $6.96
J1453 A $1.72
J1455 A $13.32
J1458 A $360.29
J1459 A $36.73
J1460 A $23.98
J1556 A $38.64
J1557 A $37.37
J1559 A $7.65
J1560 A $239.81
J1561 A $39.77
J1566 A $36.85
J1568 A $30.62
J1569 A $39.34
J1570 A $72.10
J1571 A $51.29
J1572 A $36.06
J1573 A $51.29
J1595 A $151.41
J1602 A $24.38
J1610 A $133.01
J1640 A $16.49
J1670 A $274.42
J1725 A $2.70
J1740 A $157.93
J1742 A $87.50
J1743 A $469.09
J1744 A $254.91
J1745 A $70.11
J1750 A $12.04
J1786 A $42.00
J1830 A $290.53
J1930 A $37.89
J1931 A $28.31
J1945 A $256.73
J1950 A $748.52
J2020 A $40.61
J2212 A $0.47
J2248 A $0.97
J2278 A $6.60
J2315 A $2.75
J2323 A $13.99
J2325 A $60.61
J2353 A $137.28
J2355 A $276.67
J2357 A $25.62
J2358 A $2.75
J2425 A $14.41
J2426 A $7.65
J2469 A $19.35
J2503 A $1,028.97
J2504 A $275.88
J2505 A $3,226.34
J2507 A $570.00
J2515 A $32.24
J2562 A $298.78
J2597 A $5.30
J2670 A $40.01
J2724 A $14.26
J2730 A $89.56
J2760 A $116.08
J2770 A $198.60
J2778 A $397.20
J2783 A $214.39
J2791 A $4.72
J2792 A $18.89
J2793 A $24.09
J2794 A $5.94
J2796 A $51.61
J2820 A $29.73
J2850 A $27.49
J2993 A $2,301.91
J2997 A $59.62
J3060 A $30.90
J3095 A $4.11
J3101 A $79.02
J3240 A $1,210.17
J3243 A $1.77
J3246 A $8.98
J3262 A $3.70
J3285 A $61.24
J3300 A $3.70
J3315 A $185.74
J3350 A $122.40
J3355 A $68.94
J3357 A $147.87
J3385 A $355.13
J3396 A $10.63
J3465 A $4.10
J3489 A $105.42
J7178 A $0.96
J7180 A $6.74
J7183 A $0.90
J7185 A $1.14
J7186 A $0.94
J7187 A $0.90
J7189 A $1.68
J7190 A $0.94
J7191 A $0.20
J7192 A $1.14
J7193 A $0.97
J7194 A $1.10
J7195 A $1.33
J7196 A $103.35
J7197 A $3.13
J7198 A $1.64
J7308 A $249.10
J7309 A $83.69
J7310 A $16,960.00
J7311 A $19,345.00
J7312 A $195.87
J7315 A $379.47
J7316 A $1,046.75
J7321 A $91.32
J7323 A $152.02
J7324 A $176.65
J7325 A $12.86
J7326 A $555.99
J7335 A $25.55
J7501 A $217.30
J7504 A $737.44
J7505 A $6.62
J7508 A $0.42
J7511 A $571.07
J7513 A $526.34
J7525 A $136.16
J8501 A $6.78
J8520 A $10.02
J8521 A $33.35
J8560 A $58.79
J8650 A $27.07
J8700 A $9.69
J8705 A $89.31
J9010 A $582.30
J9015 A $1,671.19
J9017 A $49.24
J9019 A $344.38
J9020 A $64.57
J9025 A $5.44
J9027 A $129.62
J9031 A $119.42
J9033 A $21.35
J9035 A $65.66
J9041 A $45.57
J9042 A $106.86
J9043 A $139.04
J9047 A $29.29
J9050 A $1,424.26
J9055 A $52.54
J9065 A $22.26
J9070 A $52.46
J9098 A $544.54
J9120 A $645.75
J9150 A $26.12
J9151 A $243.80
J9155 A $3.52
J9160 A $1,646.18
J9171 A $4.63
J9179 A $98.24
J9185 A $71.08
J9200 A $69.39
J9202 A $194.42
J9207 A $68.65
J9208 A $35.81
J9211 A $35.68
J9213 A $53.66
J9214 A $20.65
J9215 A $31.80
J9216 A $2,694.57
J9217 A $209.09
J9218 A $8.76
J9225 A $2,941.84
J9226 A $16,632.03
J9228 A $128.97
J9230 A $154.70
J9245 A $1,248.74
J9261 A $130.77
J9262 A $2.48
J9263 A $0.27
J9264 A $9.52
J9266 A $6,007.38
J9268 A $1,423.21
J9280 A $23.56
J9293 A $33.71
J9300 A $2,742.59
J9302 A $47.18
J9303 A $91.23
J9305 A $60.07
J9306 A $10.21
J9307 A $191.65
J9310 A $693.36
J9315 A $260.65
J9320 A $278.44
J9328 A $5.14
J9330 A $57.01
J9340 A $630.70
J9351 A $2.37
J9354 A $29.17
J9355 A $80.59
J9357 A $1,060.07
J9371 A $2,067.00
J9395 A $89.65
J9400 A $9.37
J9600 A $19,325.78
P9041 A $20.94
P9045 A $68.22
P9046 A $34.13
P9047 A $69.57
Q0138 A $0.69
Q2017 A $346.95
Q2043 A $33,480.93
Q2049 A $498.26
Q2050 A $513.48
Q3027 A $32.83
Q4122 A $76.18
Q4127 A $13.78
Q4131 A $213.20
Q4132 A $128.16
Q4133 A $115.19
90371 A $112.64
90375 A $218.81
90376 A $213.65
90378 A $1,308.40
90396 A $675.22
90581 A $94.05
90585 A $119.42
90675 A $236.02
90676 A $158.42
90704 A $162.34
90733 A $106.49
90734 A $97.57
90735 A $104.13
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.

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