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Revised July 2014 3rd QTR ASC Drug File

Revised: 03.30.15

Effective 07.01.2014

HCPCS Code Status Indicator Amount
A9520 A $240.00
C9021 A $54.34
C9022 A $226.42
C9121 A $16.57
C9132 A $1.54
C9133 A $1.22
C9134 A $14.10
C9250 A $34.70
C9257 A $1.66
C9290 A $1.11
C9293 A $245.42
C9399 C $0.00
C9497 A $153.70
J0129 A $32.21
J0130 A $740.83
J0132 A $2.29
J0135 A $614.34
J0178 A $980.50
J0180 A $152.02
J0207 A $294.47
J0215 A $41.64
J0220 A $206.63
J0221 A $153.64
J0256 A $4.17
J0257 A $3.95
J0287 A $10.60
J0289 A $16.42
J0300 A $194.26
J0365 A $3.42
J0401 A $3.87
J0475 A $163.54
J0476 A $76.02
J0480 A $2,619.28
J0485 A $3.82
J0490 A $39.35
J0583 A $3.45
J0585 A $5.57
J0586 A $7.46
J0587 A $11.30
J0588 A $4.48
J0594 A $28.94
J0597 A $36.33
J0598 A $51.63
J0600 A $1,679.96
J0630 A $69.05
J0637 A $12.26
J0638 A $90.98
J0641 A $1.72
J0716 A $3,635.80
J0717 A $6.53
J0740 A $600.91
J0775 A $38.70
J0795 A $7.77
J0800 A $3,299.53
J0833 A $101.68
J0840 A $2,484.42
J0850 A $1,013.87
J0878 A $0.67
J0881 A $3.70
J0885 A $11.39
J0894 A $29.40
J0897 A $14.44
J1162 A $1,645.90
J1190 A $141.05
J1205 A $131.93
J1290 A $368.90
J1300 A $206.14
J1324 A $0.55
J1327 A $27.23
J1410 A $173.60
J1430 A $310.84
J1438 A $280.13
J1442 A $1.00
J1446 A $4.09
J1451 A $6.73
J1453 A $1.72
J1455 A $13.32
J1458 A $358.75
J1459 A $37.07
J1460 A $28.68
J1556 A $37.92
J1557 A $35.62
J1559 A $7.93
J1560 A $286.78
J1561 A $40.32
J1566 A $28.71
J1568 A $31.96
J1569 A $39.68
J1570 A $75.09
J1571 A $51.64
J1572 A $38.80
J1573 A $51.64
J1595 A $170.84
J1602 A $23.93
J1610 A $140.52
J1640 A $19.02
J1670 A $305.82
J1725 A $2.68
J1740 A $160.36
J1742 A $140.52
J1743 A $483.03
J1744 A $276.84
J1745 A $72.05
J1750 A $11.83
J1786 A $42.01
J1830 A $341.80
J1930 A $39.66
J1931 A $29.39
J1945 A $256.73
J1950 A $824.50
J2020 A $44.67
J2212 A $0.44
J2248 A $0.99
J2278 A $6.87
J2315 A $2.74
J2323 A $14.95
J2325 A $65.69
J2353 A $140.48
J2355 A $317.39
J2357 A $26.57
J2358 A $2.75
J2425 A $14.87
J2426 A $7.88
J2469 A $19.26
J2503 A $1,036.45
J2504 A $279.56
J2505 A $3,349.85
J2507 A $740.26
J2515 A $34.89
J2562 A $302.12
J2597 A $5.16
J2670 A $40.01
J2724 A $14.53
J2730 A $88.40
J2760 A $106.68
J2770 A $232.85
J2778 A $396.59
J2783 A $218.60
J2791 A $4.77
J2792 A $18.96
J2793 A $24.09
J2794 A $6.14
J2796 A $53.31
J2820 A $33.37
J2850 A $27.49
J2993 A $2,301.91
J2997 A $63.73
J3060 A $30.90
J3095 A $4.14
J3101 A $79.76
J3240 A $1,431.81
J3243 A $1.95
J3246 A $9.48
J3262 A $3.69
J3285 A $61.24
J3300 A $3.68
J3315 A $185.89
J3350 A $122.40
J3355 A $65.49
J3357 A $156.93
J3385 A $353.32
J3396 A $10.71
J3465 A $4.17
J3489 A $61.58
J7178 A $0.96
J7180 A $6.74
J7183 A $0.94
J7185 A $1.19
J7186 A $0.93
J7187 A $0.95
J7189 A $1.72
J7190 A $0.93
J7191 A $0.20
J7192 A $1.14
J7193 A $1.01
J7194 A $1.12
J7195 A $1.37
J7196 A $103.35
J7197 A $3.14
J7198 A $1.70
J7308 A $249.10
J7309 A $83.69
J7310 A $16,960.00
J7311 A $19,227.80
J7312 A $201.40
J7315 A $379.59
J7316 A $1,046.75
J7321 A $89.86
J7323 A $156.03
J7324 A $178.89
J7325 A $12.37
J7326 A $559.95
J7335 A $26.51
J7501 A $217.30
J7504 A $824.12
J7505 A $6.62
J7508 A $0.40
J7511 A $602.26
J7513 A $526.34
J7525 A $135.02
J8501 A $7.43
J8520 A $9.84
J8521 A $32.83
J8560 A $57.88
J8650 A $28.42
J8700 A $5.90
J8705 A $94.65
J9010 A $582.30
J9015 A $1,828.73
J9017 A $51.04
J9019 A $354.76
J9020 A $64.56
J9025 A $4.25
J9027 A $132.93
J9031 A $122.18
J9033 A $21.72
J9035 A $66.55
J9041 A $46.08
J9042 A $110.93
J9043 A $143.11
J9047 A $29.67
J9050 A $1,422.77
J9055 A $53.38
J9065 A $21.83
J9070 A $64.55
J9098 A $553.83
J9120 A $685.42
J9150 A $23.87
J9151 A $238.92
J9155 A $3.44
J9160 A $1,646.18
J9171 A $4.97
J9179 A $99.22
J9185 A $78.21
J9200 A $68.14
J9202 A $221.53
J9207 A $70.32
J9208 A $31.77
J9211 A $46.76
J9213 A $53.66
J9214 A $20.72
J9215 A $31.80
J9216 A $2,879.49
J9217 A $233.76
J9218 A $7.29
J9225 A $2,981.71
J9226 A $16,885.87
J9228 A $131.68
J9230 A $154.70
J9245 A $1,220.50
J9261 A $138.33
J9262 A $2.48
J9263 A $0.57
J9264 A $9.80
J9266 A $6,144.57
J9268 A $1,432.43
J9280 A $22.96
J9293 A $34.46
J9300 A $2,742.59
J9302 A $47.72
J9303 A $94.57
J9305 A $60.33
J9306 A $10.22
J9307 A $197.28
J9310 A $707.47
J9315 A $270.24
J9320 A $335.13
J9328 A $5.17
J9330 A $58.22
J9340 A $630.70
J9351 A $2.06
J9354 A $29.14
J9355 A $82.37
J9357 A $1,071.33
J9371 A $2,062.34
J9395 A $90.93
J9400 A $7.10
J9600 A $19,834.12
P9041 A $20.94
P9045 A $68.22
P9046 A $34.13
P9047 A $69.57
Q0138 A $0.73
Q2017 A $830.00
Q2043 A $34,357.33
Q2049 A $498.26
Q2050 A $490.84
Q3027 A $36.01
Q4121 A $21.56
Q4122 A $78.77
Q4127 A $13.78
Q4131 A $216.74
Q4132 A $137.02
Q4133 A $131.40
Q9970 A $1.06
90371 A $118.22
90375 A $241.04
90376 A $230.99
90378 A $1,308.40
90396 A $675.22
90581 A $94.05
90585 A $122.18
90675 A $230.92
90676 A $158.42
90704 A $162.34
90733 A $106.49
90734 A $90.16
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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