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.

