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October 2014 4th QTR ASC Drug File

Revised: 10.01.15

Effective 10.01.2014

HCPCS Code Status Indicator Amount
A9520 A $240.00
C9021 A $54.27
C9022 A $222.13
C9023 A $1.15
C9025 A $54.06
C9026 A $17.03
C9121 A $15.70
C9132 A $1.54
C9133 A $1.22
C9134 A $134.95
C9135 A $3.21
C9250 A $132.98
C9257 A $1.67
C9290 A $1.15
C9293 A $257.94
C9399 C $0.00
C9497 A $153.70
J0129 A $32.25
J0130 A $739.17
J0132 A $2.19
J0135 A $570.94
J0178 A $980.50
J0180 A $152.35
J0207 A $310.72
J0215 A $41.64
J0220 A $206.63
J0221 A $153.64
J0256 A $4.11
J0257 A $3.98
J0287 A $10.41
J0289 A $16.83
J0300 A $194.26
J0365 A $3.42
J0401 A $3.87
J0475 A $162.80
J0476 A $76.29
J0480 A $2,716.18
J0485 A $3.81
J0490 A $39.48
J0583 A $3.42
J0585 A $5.56
J0586 A $7.43
J0587 A $11.30
J0588 A $4.48
J0594 A $28.94
J0597 A $37.64
J0598 A $51.86
J0600 A $3,477.51
J0630 A $69.29
J0637 A $11.84
J0638 A $90.96
J0641 A $1.77
J0716 A $3,635.80
J0717 A $6.17
J0740 A $588.10
J0775 A $38.48
J0795 A $7.72
J0800 A $3,324.92
J0833 A $101.68
J0840 A $2,493.12
J0850 A $1,013.87
J0878 A $0.67
J0881 A $3.77
J0885 A $11.65
J0894 A $28.25
J0897 A $14.45
J1162 A $2,051.63
J1190 A $144.86
J1205 A $122.65
J1290 A $375.64
J1300 A $206.14
J1324 A $0.55
J1327 A $27.29
J1410 A $180.14
J1430 A $311.06
J1438 A $285.27
J1442 A $0.99
J1446 A $3.99
J1451 A $6.44
J1453 A $1.73
J1455 A $13.32
J1458 A $359.12
J1459 A $37.03
J1460 A $28.77
J1556 A $36.21
J1557 A $35.84
J1559 A $7.94
J1560 A $287.67
J1561 A $40.02
J1566 A $26.75
J1568 A $36.92
J1569 A $39.36
J1570 A $72.11
J1571 A $53.70
J1572 A $37.76
J1573 A $53.70
J1595 A $176.31
J1602 A $24.16
J1610 A $146.07
J1640 A $20.73
J1670 A $326.32
J1725 A $2.66
J1740 A $151.80
J1742 A $112.30
J1743 A $483.05
J1744 A $276.90
J1745 A $74.34
J1750 A $12.16
J1786 A $42.01
J1830 A $353.28
J1930 A $41.40
J1931 A $29.45
J1945 A $256.73
J1950 A $829.72
J2020 A $45.66
J2212 A $0.48
J2248 A $0.98
J2278 A $6.87
J2315 A $2.88
J2323 A $14.91
J2325 A $66.66
J2353 A $141.87
J2355 A $321.88
J2357 A $27.85
J2358 A $2.75
J2425 A $14.85
J2426 A $7.91
J2469 A $20.01
J2503 A $1,034.02
J2504 A $281.40
J2505 A $3,387.93
J2507 A $856.64
J2515 A $35.82
J2562 A $301.20
J2597 A $5.08
J2670 A $40.01
J2724 A $14.52
J2730 A $89.16
J2760 A $113.40
J2770 A $245.22
J2778 A $396.43
J2783 A $218.75
J2791 A $4.80
J2792 A $18.85
J2793 A $24.09
J2794 A $6.16
J2796 A $53.63
J2820 A $30.13
J2850 A $34.78
J2993 A $2,301.91
J2997 A $64.30
J3060 A $31.94
J3095 A $4.52
J3101 A $86.21
J3240 A $1,430.43
J3243 A $2.00
J3246 A $9.17
J3262 A $3.68
J3285 A $61.24
J3300 A $3.73
J3315 A $170.77
J3350 A $122.40
J3355 A $63.11
J3357 A $162.29
J3385 A $353.35
J3396 A $10.79
J3465 A $3.97
J3489 A $47.48
J7178 A $0.97
J7180 A $6.74
J7183 A $0.95
J7185 A $1.17
J7186 A $0.94
J7187 A $0.95
J7189 A $1.73
J7190 A $0.93
J7191 A $0.20
J7192 A $1.14
J7193 A $1.01
J7194 A $1.12
J7195 A $1.35
J7196 A $103.35
J7197 A $3.27
J7198 A $1.70
J7308 A $242.30
J7309 A $83.69
J7310 A $16,960.00
J7311 A $19,641.05
J7312 A $201.31
J7315 A $368.88
J7316 A $1,046.75
J7321 A $90.81
J7323 A $161.12
J7324 A $186.89
J7325 A $12.50
J7326 A $562.08
J7335 A $26.50
J7501 A $217.30
J7504 A $852.69
J7505 A $6.62
J7508 A $0.40
J7511 A $594.74
J7513 A $526.34
J7525 A $141.10
J8501 A $7.68
J8520 A $8.67
J8521 A $28.63
J8560 A $57.09
J8650 A $28.42
J8700 A $5.39
J8705 A $94.74
J9010 A $582.30
J9015 A $2,110.63
J9017 A $53.58
J9019 A $354.76
J9020 A $64.56
J9025 A $3.92
J9027 A $134.10
J9031 A $121.96
J9033 A $22.21
J9035 A $66.65
J9041 A $46.08
J9042 A $110.82
J9043 A $142.42
J9047 A $29.81
J9050 A $1,861.12
J9055 A $53.29
J9065 A $21.21
J9070 A $63.16
J9098 A $561.39
J9120 A $807.19
J9150 A $22.56
J9151 A $239.10
J9155 A $3.55
J9171 A $4.59
J9179 A $99.01
J9185 A $70.98
J9200 A $55.65
J9202 A $225.02
J9207 A $70.21
J9208 A $33.41
J9211 A $49.11
J9213 A $53.66
J9214 A $21.17
J9215 A $31.80
J9216 A $3,168.87
J9217 A $229.26
J9218 A $7.18
J9225 A $3,001.59
J9226 A $18,317.24
J9228 A $133.61
J9230 A $189.63
J9245 A $1,226.63
J9261 A $138.87
J9262 A $2.48
J9263 A $0.58
J9264 A $9.70
J9266 A $6,220.80
J9268 A $1,483.27
J9280 A $20.88
J9293 A $32.34
J9302 A $47.76
J9303 A $94.79
J9305 A $60.27
J9306 A $10.22
J9307 A $197.12
J9310 A $708.68
J9315 A $270.64
J9320 A $335.28
J9328 A $5.68
J9330 A $58.83
J9340 A $630.70
J9351 A $1.83
J9354 A $29.14
J9355 A $82.49
J9357 A $1,085.29
J9371 A $2,148.20
J9395 A $91.27
J9400 A $8.12
J9600 A $20,002.20
P9041 A $10.91
P9045 A $54.54
P9046 A $22.49
P9047 A $53.44
Q0138 A $0.74
Q2017 A $830.00
Q2043 A $34,916.42
Q2049 A $508.43
Q2050 A $490.49
Q3027 A $36.37
Q4121 A $32.42
Q4122 A $80.58
Q4127 A $13.78
Q4131 A $219.52
Q4132 A $118.03
Q4133 A $115.18
Q9970 A $1.05
90371 A $117.38
90375 A $247.57
90376 A $237.82
90378 A $1,308.40
90396 A $675.22
90581 A $94.05
90585 A $121.96
90621 A $122.70
90675 A $223.78
90676 A $158.42
90704 A $162.34
90733 A $106.49
90734 A $100.46
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 2015 by the American Medical Association.

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