Skip to Main Content

Print | Bookmark | Font Size: + |

Revised: October 2015 4th QTR ASC Drug File

Revised: 04.04.16

Effective 10.01.2015

HCPCS Code Status Indicator Amount
A9520 A $497.00
A9586 A $2,756.00
C9025 A $53.97
C9026 A $17.03
C9027 A $45.69
C9121 A $15.14
C9132 A $1.62
C9248 A $4.32
C9257 A $1.74
C9293 A $271.24
C9349 A $109.18
C9399 C $0.00
C9442 A $31.64
C9443 A $28.55
C9444 A $25.07
C9445 A $23.29
C9446 A $1.21
C9447 A $492.90
C9449 A $96.00
C9450 A $490.95
C9451 A $1.68
C9452 A $4.25
C9453 A $25.38
C9454 A $251.26
C9455 A $8.90
C9456 A $0.68
C9457 A $33.06
C9497 A $147.34
J0120 A $97.97
J0129 A $37.33
J0130 A $965.13
J0132 A $2.00
J0135 A $742.96
J0178 A $980.50
J0180 A $158.04
J0200 A $38.86
J0207 A $363.93
J0215 A $41.64
J0220 A $206.64
J0221 A $153.60
J0256 A $4.45
J0257 A $4.11
J0287 A $12.38
J0289 A $18.23
J0300 A $194.26
J0401 A $4.10
J0475 A $170.03
J0476 A $76.07
J0480 A $2,851.52
J0485 A $3.80
J0490 A $40.54
J0583 A $3.71
J0585 A $5.72
J0586 A $8.00
J0587 A $11.65
J0588 A $4.67
J0594 A $33.20
J0597 A $40.52
J0598 A $54.46
J0600 A $5,594.42
J0630 A $2,006.85
J0637 A $12.75
J0638 A $91.78
J0641 A $1.92
J0716 A $3,635.80
J0717 A $6.62
J0725 A $22.59
J0740 A $650.18
J0775 A $38.06
J0795 A $7.74
J0800 A $3,468.13
J0833 A $101.68
J0840 A $2,542.98
J0850 A $1,064.77
J0878 A $0.76
J0881 A $4.38
J0885 A $12.62
J0894 A $22.13
J0897 A $15.24
J1162 A $2,639.26
J1190 A $146.38
J1205 A $119.93
J1290 A $402.44
J1300 A $215.92
J1322 A $221.54
J1324 A $18.63
J1327 A $32.39
J1364 A $50.75
J1410 A $215.70
J1430 A $404.09
J1438 A $330.81
J1439 A $1.06
J1442 A $1.00
J1446 A $3.86
J1451 A $7.01
J1453 A $1.73
J1458 A $364.78
J1459 A $38.05
J1556 A $38.49
J1557 A $37.28
J1559 A $8.47
J1561 A $40.30
J1566 A $33.11
J1568 A $42.80
J1569 A $38.56
J1571 A $54.43
J1572 A $35.66
J1573 A $54.43
J1595 A $194.25
J1600 A $4.27
J1602 A $24.33
J1610 A $190.60
J1640 A $21.77
J1670 A $255.21
J1725 A $2.61
J1740 A $116.67
J1742 A $63.10
J1743 A $497.48
J1744 A $298.90
J1745 A $78.76
J1750 A $12.08
J1786 A $42.00
J1830 A $357.22
J1930 A $47.18
J1931 A $29.45
J1945 A $235.52
J1950 A $900.87
J2020 A $31.62
J2248 A $0.95
J2278 A $7.08
J2315 A $3.18
J2320 A $122.78
J2323 A $16.24
J2325 A $72.98
J2353 A $156.94
J2355 A $417.79
J2357 A $29.91
J2358 A $2.92
J2425 A $15.59
J2426 A $8.45
J2469 A $20.53
J2503 A $1,031.85
J2504 A $281.12
J2505 A $3,772.79
J2507 A $1,239.16
J2515 A $40.74
J2562 A $305.98
J2597 A $8.97
J2670 A $1,600.40
J2724 A $15.12
J2730 A $91.90
J2760 A $159.00
J2770 A $311.04
J2778 A $391.41
J2783 A $227.61
J2791 A $4.75
J2792 A $19.40
J2793 A $24.09
J2794 A $6.91
J2796 A $57.47
J2820 A $31.68
J2850 A $34.78
J2941 A $81.59
J2993 A $2,301.91
J2997 A $73.74
J3060 A $36.48
J3070 A $121.83
J3095 A $4.91
J3101 A $93.96
J3145 A $1.17
J3240 A $1,432.17
J3243 A $2.35
J3246 A $8.94
J3262 A $3.85
J3285 A $61.24
J3300 A $3.72
J3315 A $144.59
J3350 A $39.97
J3355 A $64.69
J3357 A $166.99
J3385 A $346.08
J3396 A $10.99
J3465 A $4.19
J3485 A $1.50
J3489 A $34.97
J7178 A $1.05
J7180 A $7.41
J7181 A $14.07
J7183 A $1.02
J7185 A $1.42
J7186 A $0.96
J7187 A $0.99
J7189 A $2.07
J7190 A $0.96
J7191 A $0.20
J7192 A $1.16
J7193 A $1.07
J7194 A $1.19
J7195 A $1.46
J7196 A $103.35
J7197 A $3.37
J7198 A $1.83
J7200 A $1.23
J7201 A $2.81
J7308 A $292.79
J7309 A $83.69
J7310 A $16,960.00
J7311 A $20,138.08
J7312 A $201.03
J7315 A $372.66
J7316 A $1,046.75
J7321 A $88.61
J7323 A $152.00
J7324 A $172.63
J7325 A $12.87
J7326 A $578.11
J7327 A $958.45
J7336 A $2.81
J7501 A $217.30
J7504 A $1,069.33
J7508 A $0.39
J7511 A $638.49
J7513 A $526.34
J7525 A $163.25
J8501 A $9.54
J8520 A $5.53
J8521 A $19.50
J8560 A $68.74
J8650 A $34.10
J8700 A $2.66
J8705 A $101.36
J9015 A $2,667.51
J9017 A $59.42
J9019 A $376.49
J9020 A $64.56
J9025 A $3.05
J9027 A $138.38
J9031 A $122.88
J9033 A $24.66
J9035 A $69.60
J9041 A $46.75
J9042 A $119.62
J9043 A $148.66
J9047 A $31.06
J9050 A $2,973.34
J9055 A $53.48
J9065 A $20.91
J9070 A $48.95
J9098 A $576.48
J9120 A $1,164.57
J9150 A $26.45
J9151 A $238.86
J9155 A $3.59
J9171 A $3.49
J9179 A $102.53
J9185 A $72.85
J9200 A $67.69
J9202 A $281.05
J9207 A $72.08
J9208 A $32.20
J9211 A $34.88
J9213 A $733.57
J9214 A $24.05
J9216 A $5,265.95
J9217 A $242.80
J9225 A $3,012.29
J9226 A $22,170.84
J9228 A $138.83
J9230 A $241.99
J9245 A $1,285.40
J9261 A $148.57
J9262 A $2.48
J9263 A $0.48
J9264 A $9.77
J9266 A $6,189.74
J9268 A $1,471.48
J9280 A $73.03
J9293 A $32.12
J9301 A $54.21
J9302 A $49.47
J9303 A $100.91
J9305 A $61.21
J9306 A $10.22
J9307 A $212.80
J9310 A $748.70
J9315 A $290.84
J9320 A $324.02
J9328 A $6.84
J9330 A $62.50
J9340 A $630.70
J9351 A $2.05
J9354 A $29.21
J9355 A $87.36
J9357 A $1,117.31
J9371 A $2,321.82
J9395 A $93.44
J9400 A $8.32
J9600 A $20,438.61
P9041 A $10.91
P9045 A $54.54
P9046 A $22.49
P9047 A $53.44
Q0138 A $0.81
Q2017 A $3,494.46
Q2043 A $36,704.05
Q2049 A $508.43
Q2050 A $443.83
Q3027 A $40.52
Q4121 A $36.00
Q4122 A $36.36
Q4127 A $14.12
Q5101 A $0.97
Q9968 A $10.80
Q9975 A $1.90
Q9978 A $474.85
Q9979 A $1,743.19
90371 A $110.39
90375 A $285.93
90376 A $252.95
90378 A $1,947.49
90396 A $1,202.24
90581 A $94.05
90585 A $122.88
90620 A $155.70
90621 A $122.70
90675 A $263.54
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.

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved