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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.

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