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Revised: July 2015 3rd QTR ASC Drug File

Revised: 04.04.16

Effective 07.01.2015

HCPCS Code Status Indicator Amount
A9520 A $357.00
A9586 A $2,756.00
C9025 A $53.97
C9026 A $17.03
C9027 A $45.69
C9121 A $14.98
C9132 A $1.62
C9248 A $4.13
C9257 A $1.74
C9293 A $257.67
C9349 A $109.18
C9399 C $0.00
C9442 A $31.65
C9443 A $27.88
C9444 A $25.10
C9445 A $23.29
C9446 A $1.21
C9447 A $492.90
C9449 A $96.27
C9450 A $490.95
C9451 A $1.68
C9452 A $4.25
C9453 A $25.40
C9454 A $190.26
C9455 A $8.74
C9497 A $148.75
J0120 A $97.97
J0129 A $35.81
J0130 A $895.87
J0132 A $2.05
J0135 A $681.16
J0178 A $980.50
J0180 A $157.93
J0200 A $38.86
J0207 A $359.08
J0215 A $41.64
J0220 A $206.64
J0221 A $153.60
J0256 A $4.38
J0257 A $4.11
J0287 A $12.02
J0289 A $17.72
J0300 A $194.26
J0401 A $4.10
J0475 A $164.08
J0476 A $75.95
J0480 A $2,845.44
J0485 A $3.80
J0490 A $40.54
J0583 A $3.73
J0585 A $5.73
J0586 A $7.55
J0587 A $11.63
J0588 A $4.63
J0594 A $33.21
J0597 A $40.53
J0598 A $54.36
J0600 A $5,594.42
J0630 A $1,162.83
J0637 A $12.54
J0638 A $91.49
J0641 A $1.74
J0716 A $3,635.80
J0717 A $5.99
J0725 A $18.57
J0740 A $546.76
J0775 A $38.05
J0795 A $7.74
J0800 A $3,392.08
J0833 A $101.68
J0840 A $2,543.00
J0850 A $1,063.35
J0878 A $0.76
J0881 A $4.06
J0885 A $12.14
J0894 A $24.29
J0897 A $15.13
J1162 A $2,359.12
J1190 A $138.21
J1205 A $136.43
J1290 A $375.38
J1300 A $213.93
J1322 A $221.63
J1324 A $18.63
J1327 A $31.56
J1364 A $51.13
J1410 A $207.39
J1430 A $375.09
J1438 A $310.74
J1439 A $1.07
J1442 A $1.00
J1446 A $3.94
J1451 A $5.74
J1453 A $1.73
J1458 A $366.82
J1459 A $38.28
J1556 A $39.01
J1557 A $36.53
J1559 A $8.17
J1561 A $39.80
J1566 A $32.25
J1568 A $38.66
J1569 A $38.78
J1571 A $53.84
J1572 A $34.75
J1573 A $53.84
J1595 A $197.37
J1600 A $4.27
J1602 A $24.04
J1610 A $176.07
J1640 A $21.58
J1670 A $337.36
J1725 A $2.64
J1740 A $114.11
J1742 A $139.40
J1743 A $497.41
J1744 A $298.62
J1745 A $76.89
J1750 A $12.09
J1786 A $42.00
J1830 A $354.36
J1930 A $47.38
J1931 A $29.45
J1945 A $235.52
J1950 A $818.66
J2020 A $38.59
J2248 A $0.97
J2278 A $7.07
J2315 A $3.18
J2320 A $122.78
J2323 A $16.40
J2325 A $71.84
J2353 A $156.48
J2355 A $402.51
J2357 A $28.86
J2358 A $2.92
J2425 A $15.59
J2426 A $8.35
J2469 A $20.84
J2503 A $1,032.16
J2504 A $276.31
J2505 A $3,678.61
J2507 A $1,167.03
J2515 A $37.94
J2562 A $305.82
J2597 A $7.61
J2670 A $1,600.40
J2724 A $15.33
J2730 A $91.90
J2760 A $159.00
J2770 A $299.90
J2778 A $393.53
J2783 A $227.41
J2791 A $4.75
J2792 A $18.86
J2793 A $24.09
J2794 A $6.89
J2796 A $56.85
J2820 A $31.73
J2850 A $34.78
J2941 A $81.59
J2993 A $2,301.91
J2997 A $73.05
J3060 A $35.23
J3070 A $115.51
J3095 A $4.85
J3101 A $88.42
J3145 A $1.17
J3240 A $1,431.67
J3243 A $2.31
J3246 A $9.12
J3262 A $3.87
J3285 A $61.24
J3300 A $3.70
J3315 A $204.24
J3350 A $39.97
J3355 A $68.02
J3357 A $164.51
J3385 A $349.28
J3396 A $10.89
J3465 A $4.26
J3485 A $1.50
J3489 A $32.24
J7178 A $1.05
J7180 A $7.41
J7181 A $13.77
J7183 A $0.99
J7185 A $1.19
J7186 A $0.96
J7187 A $0.99
J7189 A $2.04
J7190 A $0.98
J7191 A $0.20
J7192 A $1.17
J7193 A $1.06
J7194 A $1.16
J7195 A $1.48
J7196 A $103.35
J7197 A $3.28
J7198 A $1.83
J7200 A $1.24
J7201 A $2.81
J7308 A $294.15
J7309 A $83.69
J7310 A $16,960.00
J7311 A $19,882.12
J7312 A $200.90
J7315 A $375.52
J7316 A $1,046.75
J7321 A $89.31
J7323 A $152.84
J7324 A $170.40
J7325 A $12.72
J7326 A $562.15
J7327 A $963.80
J7336 A $2.80
J7501 A $217.30
J7504 A $1,032.82
J7508 A $0.39
J7511 A $621.29
J7513 A $526.34
J7525 A $149.45
J8501 A $9.36
J8520 A $6.32
J8521 A $20.60
J8560 A $59.77
J8650 A $34.10
J8700 A $2.93
J8705 A $100.49
J9015 A $2,667.51
J9017 A $59.06
J9019 A $375.61
J9020 A $64.56
J9025 A $3.26
J9027 A $137.99
J9031 A $122.44
J9033 A $24.13
J9035 A $69.61
J9041 A $46.75
J9042 A $119.81
J9043 A $146.67
J9047 A $30.56
J9050 A $2,350.27
J9055 A $53.57
J9065 A $19.82
J9070 A $55.60
J9098 A $572.40
J9120 A $928.84
J9150 A $27.19
J9151 A $239.00
J9155 A $3.58
J9171 A $3.79
J9179 A $101.93
J9185 A $73.85
J9200 A $60.24
J9202 A $249.84
J9207 A $72.16
J9208 A $30.99
J9211 A $38.85
J9213 A $733.57
J9214 A $22.61
J9216 A $4,388.29
J9217 A $220.88
J9225 A $2,953.82
J9226 A $22,185.62
J9228 A $136.95
J9230 A $232.93
J9245 A $1,305.75
J9261 A $146.85
J9262 A $2.48
J9263 A $0.54
J9264 A $9.84
J9266 A $6,233.87
J9268 A $1,507.59
J9280 A $75.80
J9293 A $31.71
J9301 A $54.19
J9302 A $48.97
J9303 A $100.35
J9305 A $61.33
J9306 A $10.22
J9307 A $212.37
J9310 A $747.57
J9315 A $290.02
J9320 A $328.98
J9328 A $6.27
J9330 A $61.83
J9340 A $630.70
J9351 A $1.48
J9354 A $29.22
J9355 A $87.24
J9357 A $1,100.38
J9371 A $2,228.61
J9395 A $92.18
J9400 A $8.27
J9600 A $20,002.20
P9041 A $10.91
P9045 A $54.54
P9046 A $22.49
P9047 A $53.44
Q0138 A $0.81
Q2017 A $2,353.72
Q2043 A $35,845.85
Q2049 A $508.43
Q2050 A $482.84
Q3027 A $38.70
Q4121 A $36.18
Q4122 A $39.28
Q4127 A $15.19
Q5101 A $0.97
Q9968 A $10.70
Q9975 A $1.89
Q9978 A $495.72
90371 A $119.96
90375 A $244.73
90376 A $254.03
90378 A $1,947.49
90396 A 708.98
90581 A 94.05
90585 A 122.44
90620 A 137.91
90621 A 122.7
90675 A 234.93
90676 A 172.3
90733 A 106.49
90735 A 108.29
90740 C 0
90743 C 0
90744 C 0
90746 C 0
90747 C 0

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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