January 2015 1st QTR ASC Drug File
Revised: 10.01.15
Effective 01.01.2015
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9520 | A | $240.00 |
| A9586 | A | $2,756.00 |
| C9025 | A | $53.97 |
| C9026 | A | $17.03 |
| C9027 | A | $45.75 |
| C9121 | A | $15.49 |
| C9132 | A | $1.61 |
| C9136 | A | $2.30 |
| C9248 | A | $4.24 |
| C9257 | A | $1.70 |
| C9293 | A | $257.67 |
| C9349 | A | $109.18 |
| C9399 | C | $0.00 |
| C9442 | A | $31.80 |
| C9443 | A | $31.59 |
| C9444 | A | $25.62 |
| C9446 | A | $0.12 |
| C9447 | A | $492.90 |
| C9497 | A | $153.70 |
| J0120 | A | $97.97 |
| J0129 | A | $33.15 |
| J0130 | A | $804.37 |
| J0132 | A | $1.56 |
| J0135 | A | $630.65 |
| J0178 | A | $980.50 |
| J0180 | A | $152.35 |
| J0200 | A | $38.86 |
| J0207 | A | $479.05 |
| J0215 | A | $41.64 |
| J0220 | A | $206.63 |
| J0221 | A | $153.62 |
| J0256 | A | $4.24 |
| J0257 | A | $3.98 |
| J0287 | A | $11.01 |
| J0289 | A | $16.98 |
| J0300 | A | $194.26 |
| J0365 | A | $174.42 |
| J0401 | A | $3.98 |
| J0475 | A | $159.74 |
| J0476 | A | $75.84 |
| J0480 | A | $2,723.28 |
| J0485 | A | $3.80 |
| J0490 | A | $40.03 |
| J0583 | A | $3.54 |
| J0585 | A | $5.58 |
| J0586 | A | $7.62 |
| J0587 | A | $11.28 |
| J0588 | A | $4.47 |
| J0594 | A | $32.86 |
| J0597 | A | $38.58 |
| J0598 | A | $51.89 |
| J0600 | A | $3,063.72 |
| J0630 | A | $358.25 |
| J0637 | A | $12.32 |
| J0638 | A | $91.00 |
| J0641 | A | $1.75 |
| J0716 | A | $3,635.80 |
| J0717 | A | $6.17 |
| J0725 | A | $18.40 |
| J0740 | A | $584.51 |
| J0775 | A | $38.45 |
| J0795 | A | $7.73 |
| J0800 | A | $3,324.95 |
| J0833 | A | $101.68 |
| J0840 | A | $2,493.12 |
| J0850 | A | $1,013.87 |
| J0878 | A | $0.71 |
| J0881 | A | $3.90 |
| J0885 | A | $11.89 |
| J0894 | A | $27.18 |
| J0897 | A | $14.69 |
| J1162 | A | $2,051.63 |
| J1190 | A | $138.61 |
| J1205 | A | $119.20 |
| J1290 | A | $374.64 |
| J1300 | A | $210.35 |
| J1322 | A | $221.70 |
| J1324 | A | $18.63 |
| J1327 | A | $28.57 |
| J1364 | A | $43.93 |
| J1410 | A | $190.66 |
| J1430 | A | $311.12 |
| J1438 | A | $299.37 |
| J1439 | A | $1.06 |
| J1442 | A | $1.00 |
| J1446 | A | $3.92 |
| J1451 | A | $6.34 |
| J1453 | A | $1.73 |
| J1458 | A | $358.97 |
| J1459 | A | $36.66 |
| J1556 | A | $38.47 |
| J1557 | A | $35.92 |
| J1559 | A | $7.95 |
| J1561 | A | $40.22 |
| J1566 | A | $26.73 |
| J1568 | A | $36.87 |
| J1569 | A | $39.15 |
| J1571 | A | $52.27 |
| J1572 | A | $36.14 |
| J1573 | A | $52.27 |
| J1595 | A | $182.83 |
| J1600 | A | $4.27 |
| J1602 | A | $23.92 |
| J1610 | A | $162.08 |
| J1640 | A | $20.73 |
| J1670 | A | $328.40 |
| J1725 | A | $2.65 |
| J1740 | A | $123.88 |
| J1742 | A | $110.02 |
| J1743 | A | $483.10 |
| J1744 | A | $276.64 |
| J1745 | A | $74.11 |
| J1750 | A | $12.12 |
| J1786 | A | $42.01 |
| J1830 | A | $347.95 |
| J1930 | A | $46.70 |
| J1931 | A | $29.45 |
| J1945 | A | $235.52 |
| J1950 | A | $810.14 |
| J2020 | A | $47.75 |
| J2248 | A | $0.95 |
| J2278 | A | $6.97 |
| J2315 | A | $2.89 |
| J2320 | A | $122.78 |
| J2323 | A | $15.49 |
| J2325 | A | $66.30 |
| J2353 | A | $143.32 |
| J2355 | A | $322.70 |
| J2357 | A | $27.68 |
| J2358 | A | $2.75 |
| J2425 | A | $15.22 |
| J2426 | A | $8.12 |
| J2469 | A | $20.15 |
| J2503 | A | $1,035.10 |
| J2504 | A | $281.40 |
| J2505 | A | $3,495.46 |
| J2507 | A | $1,006.47 |
| J2515 | A | $35.84 |
| J2562 | A | $304.06 |
| J2597 | A | $5.04 |
| J2670 | A | $1,600.40 |
| J2724 | A | $14.61 |
| J2730 | A | $87.66 |
| J2760 | A | $159.00 |
| J2770 | A | $262.29 |
| J2778 | A | $396.05 |
| J2783 | A | $223.00 |
| J2791 | A | $4.77 |
| J2792 | A | $18.64 |
| J2793 | A | $24.09 |
| J2794 | A | $6.50 |
| J2796 | A | $54.99 |
| J2820 | A | $33.15 |
| J2850 | A | $34.78 |
| J2941 | A | $76.03 |
| J2993 | A | $2,301.91 |
| J2997 | A | $68.19 |
| J3060 | A | $35.23 |
| J3070 | A | $113.72 |
| J3095 | A | $4.79 |
| J3101 | A | $86.23 |
| J3145 | A | $1.14 |
| J3240 | A | $1,428.67 |
| J3243 | A | $2.08 |
| J3246 | A | $9.00 |
| J3262 | A | $3.80 |
| J3285 | A | $61.24 |
| J3300 | A | $3.74 |
| J3315 | A | $169.45 |
| J3350 | A | $39.97 |
| J3355 | A | $62.14 |
| J3357 | A | $160.48 |
| J3385 | A | $352.81 |
| J3396 | A | $10.75 |
| J3465 | A | $3.73 |
| J3485 | A | $1.50 |
| J3489 | A | $41.29 |
| J7178 | A | $1.01 |
| J7180 | A | $35.23 |
| J7181 | A | $13.81 |
| J7183 | A | $0.96 |
| J7185 | A | $1.19 |
| J7186 | A | $0.95 |
| J7187 | A | $0.96 |
| J7189 | A | $1.77 |
| J7190 | A | $0.94 |
| J7191 | A | $0.20 |
| J7192 | A | $1.14 |
| J7193 | A | $1.04 |
| J7194 | A | $1.14 |
| J7195 | A | $1.35 |
| J7196 | A | $103.35 |
| J7197 | A | $3.27 |
| J7198 | A | $1.76 |
| J7200 | A | $1.24 |
| J7201 | A | $2.82 |
| J7308 | A | $244.25 |
| J7309 | A | $83.69 |
| J7310 | A | $16,960.00 |
| J7311 | A | $19,725.67 |
| J7312 | A | $201.25 |
| J7315 | A | $372.80 |
| J7316 | A | $1,046.75 |
| J7321 | A | $88.90 |
| J7323 | A | $154.62 |
| J7324 | A | $174.75 |
| J7325 | A | $12.74 |
| J7326 | A | $563.86 |
| J7327 | A | $988.38 |
| J7336 | A | $2.73 |
| J7501 | A | $217.30 |
| J7504 | A | $902.25 |
| J7508 | A | $0.39 |
| J7511 | A | $588.77 |
| J7513 | A | $526.34 |
| J7525 | A | $149.15 |
| J8501 | A | $7.67 |
| J8520 | A | $8.10 |
| J8521 | A | $26.34 |
| J8560 | A | $56.88 |
| J8650 | A | $28.42 |
| J8700 | A | $3.65 |
| J8705 | A | $97.56 |
| J9015 | A | $2,319.58 |
| J9017 | A | $53.72 |
| J9019 | A | $364.68 |
| J9020 | A | $64.56 |
| J9025 | A | $3.67 |
| J9027 | A | $134.03 |
| J9031 | A | $120.44 |
| J9033 | A | $22.72 |
| J9035 | A | $67.90 |
| J9041 | A | $46.55 |
| J9042 | A | $115.39 |
| J9043 | A | $142.38 |
| J9047 | A | $30.03 |
| J9050 | A | $1,982.07 |
| J9055 | A | $53.75 |
| J9065 | A | $21.98 |
| J9070 | A | $58.02 |
| J9098 | A | $559.09 |
| J9120 | A | $807.19 |
| J9150 | A | $27.70 |
| J9151 | A | $238.92 |
| J9155 | A | $3.42 |
| J9171 | A | $3.98 |
| J9179 | A | $100.08 |
| J9185 | A | $88.90 |
| J9200 | A | $60.25 |
| J9202 | A | $230.01 |
| J9207 | A | $71.34 |
| J9208 | A | $30.83 |
| J9211 | A | $42.26 |
| J9213 | A | $733.57 |
| J9214 | A | $21.28 |
| J9216 | A | $4,025.96 |
| J9217 | A | $237.16 |
| J9225 | A | $3,000.24 |
| J9226 | A | $20,115.46 |
| J9228 | A | $133.66 |
| J9230 | A | $194.13 |
| J9245 | A | $1,292.71 |
| J9261 | A | $142.92 |
| J9262 | A | $2.48 |
| J9263 | A | $0.59 |
| J9264 | A | $9.69 |
| J9266 | A | $6,200.82 |
| J9268 | A | $1,510.36 |
| J9280 | A | $39.86 |
| J9293 | A | $34.79 |
| J9301 | A | $54.24 |
| J9302 | A | $48.35 |
| J9303 | A | $96.98 |
| J9305 | A | $60.70 |
| J9306 | A | $10.22 |
| J9307 | A | $204.47 |
| J9310 | A | $725.44 |
| J9315 | A | $279.81 |
| J9320 | A | $336.01 |
| J9328 | A | $5.71 |
| J9330 | A | $60.04 |
| J9340 | A | $630.70 |
| J9351 | A | $1.53 |
| J9354 | A | $29.17 |
| J9355 | A | $84.45 |
| J9357 | A | $1,098.82 |
| J9371 | A | $2,142.60 |
| J9395 | A | $91.30 |
| J9400 | A | $7.62 |
| J9600 | A | $20,002.20 |
| P9041 | A | $10.91 |
| P9045 | A | $54.54 |
| P9046 | A | $22.49 |
| P9047 | A | $53.44 |
| Q0138 | A | $0.78 |
| Q2017 | A | $825.50 |
| Q2043 | A | $34,775.98 |
| Q2049 | A | $508.43 |
| Q2050 | A | $489.99 |
| Q3027 | A | $36.69 |
| Q4121 | A | $36.16 |
| Q4122 | A | $82.30 |
| Q4127 | A | $19.88 |
| Q9968 | A | $1.61 |
| 90371 | A | $116.67 |
| 90375 | A | $243.58 |
| 90376 | A | $225.42 |
| 90378 | A | $1,947.79 |
| 90396 | A | $675.22 |
| 90581 | A | $94.05 |
| 90585 | A | $120.44 |
| 90620 | A | $155.70 |
| 90621 | A | $122.70 |
| 90675 | A | $234.29 |
| 90676 | A | $172.30 |
| 90733 | A | $106.49 |
| 90735 | A | $108.29 |
| 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.

