Revised: April 2015 2nd QTR ASC Drug File
Revised: 04.04.16
Effective 04.01.2015
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9520 | A | $357.00 |
| A9586 | A | $2,756.00 |
| C9025 | A | $53.97 |
| C9026 | A | $17.03 |
| C9027 | A | $45.70 |
| C9121 | A | $16.32 |
| C9132 | A | $1.62 |
| C9248 | A | $3.84 |
| C9257 | A | $1.71 |
| C9293 | A | $257.67 |
| C9349 | A | $109.18 |
| C9399 | C | $0.00 |
| C9442 | A | $31.69 |
| C9443 | A | $29.57 |
| C9444 | A | $25.62 |
| C9445 | A | $23.98 |
| C9446 | A | $1.21 |
| C9447 | A | $492.90 |
| C9448 | A | $504.56 |
| C9449 | A | $96.27 |
| C9450 | A | $490.95 |
| C9451 | A | $1.68 |
| C9452 | A | $4.40 |
| C9497 | A | $149.85 |
| J0120 | A | $97.97 |
| J0129 | A | $34.92 |
| J0130 | A | $823.78 |
| J0132 | A | $2.10 |
| J0135 | A | $658.71 |
| J0178 | A | $980.50 |
| J0180 | A | $152.34 |
| J0200 | A | $38.86 |
| J0207 | A | $361.77 |
| J0215 | A | $41.64 |
| J0220 | A | $206.63 |
| J0221 | A | $153.61 |
| J0256 | A | $4.33 |
| J0257 | A | $4.02 |
| J0287 | A | $11.65 |
| J0289 | A | $17.10 |
| J0300 | A | $194.26 |
| J0401 | A | $3.98 |
| J0475 | A | $169.81 |
| J0476 | A | $76.50 |
| J0480 | A | $2,718.40 |
| J0485 | A | $3.80 |
| J0490 | A | $40.02 |
| J0583 | A | $3.50 |
| J0585 | A | $5.57 |
| J0586 | A | $7.95 |
| J0587 | A | $11.29 |
| J0588 | A | $4.61 |
| J0594 | A | $33.23 |
| J0597 | A | $38.57 |
| J0598 | A | $51.90 |
| J0600 | A | $4,430.35 |
| J0630 | A | $956.69 |
| J0637 | A | $11.84 |
| J0638 | A | $91.09 |
| J0641 | A | $1.80 |
| J0716 | A | $3,635.80 |
| J0717 | A | $6.05 |
| J0725 | A | $19.38 |
| J0740 | A | $553.01 |
| J0775 | A | $38.42 |
| J0795 | A | $7.74 |
| J0800 | A | $3,339.97 |
| J0833 | A | $101.68 |
| J0840 | A | $2,493.12 |
| J0850 | A | $1,013.87 |
| J0878 | A | $0.71 |
| J0881 | A | $3.73 |
| J0885 | A | $11.84 |
| J0894 | A | $26.11 |
| J0897 | A | $14.71 |
| J1162 | A | $2,361.31 |
| J1190 | A | $137.57 |
| J1205 | A | $122.24 |
| J1290 | A | $375.78 |
| J1300 | A | $211.89 |
| J1322 | A | $221.75 |
| J1324 | A | $18.63 |
| J1327 | A | $29.17 |
| J1364 | A | $43.46 |
| J1410 | A | $190.66 |
| J1430 | A | $311.12 |
| J1438 | A | $302.37 |
| J1439 | A | $1.07 |
| J1442 | A | $0.99 |
| J1446 | A | $3.85 |
| J1451 | A | $5.81 |
| J1453 | A | $1.73 |
| J1458 | A | $362.37 |
| J1459 | A | $37.45 |
| J1556 | A | $36.35 |
| J1557 | A | $36.38 |
| J1559 | A | $8.18 |
| J1561 | A | $39.91 |
| J1566 | A | $28.95 |
| J1568 | A | $40.55 |
| J1569 | A | $39.21 |
| J1571 | A | $53.86 |
| J1572 | A | $35.54 |
| J1573 | A | $53.86 |
| J1595 | A | $186.78 |
| J1600 | A | $4.27 |
| J1602 | A | $24.20 |
| J1610 | A | $156.78 |
| J1640 | A | $20.73 |
| J1670 | A | $325.95 |
| J1725 | A | $2.64 |
| J1740 | A | $124.12 |
| J1742 | A | $114.69 |
| J1743 | A | $497.69 |
| J1744 | A | $276.35 |
| J1745 | A | $76.51 |
| J1750 | A | $12.12 |
| J1786 | A | $42.00 |
| J1830 | A | $352.37 |
| J1930 | A | $46.67 |
| J1931 | A | $29.45 |
| J1945 | A | $235.52 |
| J1950 | A | $813.38 |
| J2020 | A | $47.71 |
| J2248 | A | $0.93 |
| J2278 | A | $6.97 |
| J2315 | A | $2.97 |
| J2320 | A | $122.78 |
| J2323 | A | $15.82 |
| J2325 | A | $66.31 |
| J2353 | A | $144.69 |
| J2355 | A | $322.27 |
| J2357 | A | $28.79 |
| J2358 | A | $2.92 |
| J2425 | A | $15.61 |
| J2426 | A | $8.13 |
| J2469 | A | $19.95 |
| J2503 | A | $1,040.51 |
| J2504 | A | $275.40 |
| J2505 | A | $3,500.59 |
| J2507 | A | $740.26 |
| J2515 | A | $36.91 |
| J2562 | A | $304.00 |
| J2597 | A | $5.52 |
| J2670 | A | $1,600.40 |
| J2724 | A | $15.10 |
| J2730 | A | $88.51 |
| J2760 | A | $127.71 |
| J2770 | A | $262.20 |
| J2778 | A | $395.54 |
| J2783 | A | $223.35 |
| J2791 | A | $4.79 |
| J2792 | A | $18.90 |
| J2793 | A | $24.09 |
| J2794 | A | $6.53 |
| J2796 | A | $55.27 |
| J2820 | A | $31.76 |
| J2850 | A | $34.78 |
| J2941 | A | $76.43 |
| J2993 | A | $2,301.91 |
| J2997 | A | $68.44 |
| J3060 | A | $35.23 |
| J3070 | A | $117.99 |
| J3095 | A | $4.55 |
| J3101 | A | $86.21 |
| J3145 | A | $1.16 |
| J3240 | A | $1,420.44 |
| J3243 | A | $2.08 |
| J3246 | A | $8.80 |
| J3262 | A | $3.77 |
| J3285 | A | $61.24 |
| J3300 | A | $3.72 |
| J3315 | A | $180.19 |
| J3350 | A | $39.97 |
| J3355 | A | $58.63 |
| J3357 | A | $163.47 |
| J3385 | A | $350.59 |
| J3396 | A | $10.89 |
| J3465 | A | $3.71 |
| J3485 | A | $1.50 |
| J3489 | A | $38.23 |
| J7178 | A | $1.01 |
| J7180 | A | $7.05 |
| J7181 | A | $13.73 |
| J7183 | A | $0.98 |
| J7185 | A | $1.18 |
| J7186 | A | $0.96 |
| J7187 | A | $0.99 |
| J7189 | A | $1.76 |
| J7190 | A | $0.94 |
| J7191 | A | $0.20 |
| J7192 | A | $1.15 |
| J7193 | A | $1.05 |
| J7194 | A | $1.13 |
| J7195 | A | $1.37 |
| J7196 | A | $103.35 |
| J7197 | A | $3.27 |
| J7198 | A | $1.77 |
| J7200 | A | $1.24 |
| J7201 | A | $2.82 |
| J7308 | A | $294.15 |
| J7309 | A | $83.69 |
| J7310 | A | $16,960.00 |
| J7311 | A | $19,710.73 |
| J7312 | A | $201.21 |
| J7315 | A | $373.97 |
| J7316 | A | $1,046.75 |
| J7321 | A | $89.21 |
| J7323 | A | $148.51 |
| J7324 | A | $177.07 |
| J7325 | A | $12.66 |
| J7326 | A | $561.43 |
| J7327 | A | $979.01 |
| J7336 | A | $2.73 |
| J7501 | A | $217.30 |
| J7504 | A | $901.42 |
| J7508 | A | $0.39 |
| J7511 | A | $594.06 |
| J7513 | A | $526.34 |
| J7525 | A | $149.11 |
| J8501 | A | $8.48 |
| J8520 | A | $6.96 |
| J8521 | A | $23.22 |
| J8560 | A | $57.50 |
| J8650 | A | $34.10 |
| J8700 | A | $3.37 |
| J8705 | A | $97.67 |
| J9015 | A | $2,667.51 |
| J9017 | A | $53.85 |
| J9019 | A | $364.32 |
| J9020 | A | $64.56 |
| J9025 | A | $3.46 |
| J9027 | A | $134.31 |
| J9031 | A | $121.95 |
| J9033 | A | $23.29 |
| J9035 | A | $68.48 |
| J9041 | A | $46.57 |
| J9042 | A | $115.17 |
| J9043 | A | $145.55 |
| J9047 | A | $30.46 |
| J9050 | A | $1,983.52 |
| J9055 | A | $53.27 |
| J9065 | A | $22.96 |
| J9070 | A | $58.40 |
| J9098 | A | $560.53 |
| J9120 | A | $913.30 |
| J9150 | A | $26.27 |
| J9151 | A | $239.09 |
| J9155 | A | $3.48 |
| J9171 | A | $2.77 |
| J9179 | A | $100.42 |
| J9185 | A | $69.70 |
| J9200 | A | $38.01 |
| J9202 | A | $269.92 |
| J9207 | A | $70.99 |
| J9208 | A | $32.44 |
| J9211 | A | $40.15 |
| J9213 | A | $733.57 |
| J9214 | A | $22.58 |
| J9216 | A | $4,388.29 |
| J9217 | A | $228.17 |
| J9225 | A | $2,980.19 |
| J9226 | A | $21,173.64 |
| J9228 | A | $135.59 |
| J9230 | A | $193.37 |
| J9245 | A | $1,292.39 |
| J9261 | A | $142.66 |
| J9262 | A | $2.48 |
| J9263 | A | $0.52 |
| J9264 | A | $9.68 |
| J9266 | A | $6,218.44 |
| J9268 | A | $1,489.23 |
| J9280 | A | $65.85 |
| J9293 | A | $31.95 |
| J9301 | A | $54.21 |
| J9302 | A | $48.32 |
| J9303 | A | $97.27 |
| J9305 | A | $60.84 |
| J9306 | A | $10.22 |
| J9307 | A | $204.81 |
| J9310 | A | $731.98 |
| J9315 | A | $278.64 |
| J9320 | A | $336.91 |
| J9328 | A | $6.23 |
| J9330 | A | $60.08 |
| J9340 | A | $630.70 |
| J9351 | A | $2.16 |
| J9354 | A | $29.22 |
| J9355 | A | $85.22 |
| J9357 | A | $1,100.04 |
| J9371 | A | $2,226.99 |
| J9395 | A | $92.35 |
| J9400 | A | $8.15 |
| J9600 | A | $20,002.20 |
| P9041 | A | $10.91 |
| P9045 | A | $54.54 |
| P9046 | A | $22.49 |
| P9047 | A | $53.44 |
| Q0138 | A | $0.79 |
| Q2017 | A | $919.82 |
| Q2043 | A | $35,880.08 |
| Q2049 | A | $508.43 |
| Q2050 | A | $488.48 |
| Q3027 | A | $38.50 |
| Q4121 | A | $35.13 |
| Q4122 | A | $82.32 |
| Q4127 | A | $16.81 |
| Q9968 | A | $10.46 |
| Q9975 | A | $1.92 |
| 90371 | A | $104.56 |
| 90375 | A | $248.30 |
| 90376 | A | $242.39 |
| 90378 | A | $1,947.79 |
| 90396 | A | $709.07 |
| 90581 | A | $94.05 |
| 90585 | A | $121.95 |
| 90620 | A | $155.70 |
| 90621 | A | $122.70 |
| 90675 | A | $237.38 |
| 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.

