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Revised April 2014 2nd QTR ASC Drug File

Revised: 03.30.15

Effective 04.01.2014

HCPCS Code Status Indicator Amount
A9520 A $240.00
C9021 A $54.70
C9121 A $16.62
C9132 A $1.54
C9133 A $1.27
C9250 A $33.77
C9257 A $1.64
C9290 A $1.10
C9293 A $245.42
C9399 C $0.00
C9441 A $1.03
C9497 A $153.70
J0129 A $23.88
J0130 A $741.89
J0132 A $2.48
J0135 A $567.68
J0178 A $980.50
J0180 A $146.20
J0207 A $311.76
J0215 A $41.64
J0220 A $206.62
J0221 A $153.63
J0256 A $4.11
J0257 A $3.96
J0287 A $10.43
J0289 A $16.31
J0300 A $179.87
J0365 A $3.42
J0401 A $3.77
J0475 A $161.31
J0476 A $75.50
J0480 A $2,561.77
J0485 A $3.79
J0490 A $38.83
J0583 A $3.21
J0585 A $5.43
J0586 A $7.34
J0587 A $11.14
J0588 A $4.48
J0594 A $28.94
J0597 A $36.35
J0598 A $49.21
J0600 A $1,508.65
J0630 A $69.02
J0637 A $13.09
J0638 A $91.03
J0641 A $1.70
J0716 A $3,661.21
J0717 A $5.93
J0740 A $614.05
J0775 A $38.43
J0795 A $7.75
J0800 A $3,165.42
J0833 A $101.68
J0840 A $2,420.00
J0850 A $1,013.87
J0878 A $0.64
J0881 A $3.73
J0885 A $11.46
J0894 A $29.86
J0897 A $14.32
J1162 A $1,303.69
J1190 A $136.54
J1205 A $141.93
J1290 A $354.67
J1300 A $206.14
J1324 A $0.55
J1327 A $27.58
J1410 A $163.74
J1430 A $299.94
J1438 A $266.93
J1442 A $1.00
J1446 A $4.22
J1451 A $6.70
J1453 A $1.72
J1455 A $13.32
J1458 A $359.82
J1459 A $36.75
J1460 A $24.78
J1556 A $38.22
J1557 A $36.23
J1559 A $7.68
J1560 A $247.83
J1561 A $39.50
J1566 A $30.04
J1568 A $30.50
J1569 A $39.17
J1570 A $73.97
J1571 A $50.35
J1572 A $36.33
J1573 A $50.35
J1595 A $149.84
J1602 A $23.89
J1610 A $131.90
J1640 A $16.59
J1670 A $298.41
J1725 A $2.68
J1740 A $158.19
J1742 A $73.51
J1743 A $482.22
J1744 A $275.86
J1745 A $71.35
J1750 A $11.93
J1786 A $42.01
J1830 A $306.68
J1930 A $38.94
J1931 A $28.31
J1945 A $256.73
J1950 A $760.03
J2020 A $40.97
J2212 A $0.44
J2248 A $0.99
J2278 A $6.60
J2315 A $2.76
J2323 A $13.97
J2325 A $60.25
J2353 A $139.09
J2355 A $276.23
J2357 A $26.50
J2358 A $2.75
J2425 A $14.41
J2426 A $7.68
J2469 A $19.59
J2503 A $1,027.98
J2504 A $275.88
J2505 A $3,299.46
J2507 A $566.03
J2515 A $33.10
J2562 A $299.84
J2597 A $5.15
J2670 A $40.01
J2724 A $14.27
J2730 A $88.54
J2760 A $101.30
J2770 A $198.70
J2778 A $397.01
J2783 A $214.61
J2791 A $4.75
J2792 A $18.74
J2793 A $24.09
J2794 A $5.98
J2796 A $51.82
J2820 A $32.45
J2850 A $27.49
J2993 A $2,301.91
J2997 A $60.32
J3060 A $30.90
J3095 A $4.14
J3101 A $79.05
J3240 A $1,211.24
J3243 A $1.77
J3246 A $9.31
J3262 A $3.71
J3285 A $61.24
J3300 A $3.71
J3315 A $184.73
J3350 A $122.40
J3355 A $63.43
J3357 A $151.47
J3385 A $355.23
J3396 A $11.05
J3465 A $3.78
J3489 A $81.43
J7178 A $0.96
J7180 A $6.74
J7183 A $0.90
J7185 A $1.13
J7186 A $0.94
J7187 A $0.95
J7189 A $1.71
J7190 A $0.92
J7191 A $0.20
J7192 A $1.13
J7193 A $0.98
J7194 A $1.10
J7195 A $1.32
J7196 A $103.35
J7197 A $3.15
J7198 A $1.64
J7308 A $249.10
J7309 A $83.69
J7310 A $16,960.00
J7311 A $19,345.00
J7312 A $197.26
J7315 A $379.66
J7316 A $1,046.70
J7321 A $89.62
J7323 A $154.61
J7324 A $185.11
J7325 A $12.33
J7326 A $582.53
J7335 A $25.49
J7501 A $217.30
J7504 A $742.89
J7505 A $6.62
J7508 A $0.40
J7511 A $541.17
J7513 A $526.34
J7525 A $136.28
J8501 A $7.45
J8520 A $10.06
J8521 A $33.56
J8560 A $58.16
J8650 A $28.42
J8700 A $6.94
J8705 A $91.93
J9010 A $582.30
J9015 A $1,833.94
J9017 A $49.22
J9019 A $344.38
J9020 A $64.57
J9025 A $4.84
J9027 A $129.63
J9031 A $122.36
J9033 A $21.35
J9035 A $65.58
J9041 A $45.57
J9042 A $106.68
J9043 A $142.08
J9047 A $29.29
J9050 A $1,414.63
J9055 A $52.53
J9065 A $23.28
J9070 A $52.45
J9098 A $544.51
J9120 A $645.75
J9150 A $25.45
J9151 A $243.80
J9155 A $3.10
J9160 A $1,646.18
J9171 A $4.35
J9179 A $98.29
J9185 A $84.65
J9200 A $78.26
J9202 A $216.85
J9207 A $68.62
J9208 A $34.17
J9211 A $29.38
J9213 A $53.66
J9214 A $20.66
J9215 A $31.80
J9216 A $2,879.49
J9217 A $206.78
J9218 A $7.90
J9225 A $2,980.71
J9226 A $16,875.98
J9228 A $130.87
J9230 A $154.70
J9245 A $1,228.70
J9261 A $134.70
J9262 A $2.48
J9263 A $0.56
J9264 A $9.47
J9266 A $6,007.38
J9268 A $1,451.03
J9280 A $23.02
J9293 A $34.10
J9300 A $2,742.59
J9302 A $47.20
J9303 A $94.23
J9305 A $59.96
J9306 A $10.21
J9307 A $189.72
J9310 A $693.90
J9315 A $259.98
J9320 A $339.35
J9328 A $5.14
J9330 A $57.09
J9340 A $630.70
J9351 A $2.19
J9354 A $29.13
J9355 A $80.64
J9357 A $1,071.49
J9371 A $2,067.00
J9395 A $90.89
J9400 A $8.07
J9600 A $19,325.78
P9041 A $20.94
P9045 A $68.22
P9046 A $34.13
P9047 A $69.57
Q0138 A $0.72
Q2017 A $676.84
Q2043 A $34,998.06
Q2049 A $498.26
Q2050 A $487.96
Q3027 A $33.93
Q4121 A $23.18
Q4122 A $75.40
Q4127 A $13.78
Q4131 A $212.82
Q4132 A $121.49
Q4133 A $129.76
90371 A $111.45
90375 A $220.15
90376 A $213.04
90378 A $1,308.40
90396 A $675.22
90581 A $94.05
90585 A $122.36
90675 A $231.77
90676 A $158.42
90704 A $162.34
90733 A $106.49
90734 A $86.80
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 2013 by the American Medical Association.

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