Revised: January 2016 1st QTR ASC Drug File
Revised: 07.05.16
Effective 01.01.2016
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9586 | A | $2,756.00 |
| C9121 | A | $14.17 |
| C9132 | A | $1.69 |
| C9248 | A | $2.82 |
| C9257 | A | $1.77 |
| C9293 | A | $270.56 |
| C9349 | A | $119.43 |
| C9399 | C | $0.00 |
| C9447 | A | $490.14 |
| C9458 | A | $2,968.00 |
| C9459 | A | $3,135.00 |
| C9460 | A | $15.88 |
| C9497 | A | $153.70 |
| J0120 | A | $97.97 |
| J0129 | A | $39.44 |
| J0130 | A | $1,015.54 |
| J0132 | A | $1.72 |
| J0135 | A | $753.26 |
| J0178 | A | $980.50 |
| J0180 | A | $158.48 |
| J0202 | A | $1,743.82 |
| J0207 | A | $377.88 |
| J0215 | A | $41.64 |
| J0220 | A | $206.70 |
| J0221 | A | $153.60 |
| J0256 | A | $4.59 |
| J0257 | A | $4.27 |
| J0287 | A | $13.03 |
| J0289 | A | $18.18 |
| J0300 | A | $194.26 |
| J0401 | A | $4.25 |
| J0475 | A | $165.96 |
| J0476 | A | $76.40 |
| J0480 | A | $3,007.97 |
| J0485 | A | $3.80 |
| J0490 | A | $41.46 |
| J0561 | A | $8.33 |
| J0583 | A | $3.01 |
| J0585 | A | $5.72 |
| J0586 | A | $7.90 |
| J0587 | A | $11.61 |
| J0588 | A | $4.77 |
| J0594 | A | $33.18 |
| J0596 | A | $25.60 |
| J0597 | A | $46.32 |
| J0598 | A | $54.48 |
| J0600 | A | $5,594.42 |
| J0630 | A | $1,997.76 |
| J0637 | A | $12.94 |
| J0638 | A | $92.12 |
| J0641 | A | $1.62 |
| J0695 | A | $4.28 |
| J0712 | A | $2.27 |
| J0714 | A | $73.87 |
| J0716 | A | $3,926.66 |
| J0717 | A | $6.47 |
| J0720 | A | $31.74 |
| J0725 | A | $20.21 |
| J0740 | A | $566.86 |
| J0775 | A | $38.46 |
| J0795 | A | $7.72 |
| J0800 | A | $3,578.55 |
| J0833 | A | $101.68 |
| J0840 | A | $2,542.98 |
| J0850 | A | $1,064.77 |
| J0875 | A | $14.58 |
| J0878 | A | $0.80 |
| J0881 | A | $4.15 |
| J0885 | A | $12.33 |
| J0887 | A | $11.29 |
| J0894 | A | $21.78 |
| J0897 | A | $15.49 |
| J1160 | A | $4.58 |
| J1162 | A | $2,642.71 |
| J1190 | A | $166.78 |
| J1205 | A | $115.84 |
| J1212 | A | $217.54 |
| J1290 | A | $404.68 |
| J1300 | A | $215.92 |
| J1322 | A | $221.75 |
| J1324 | A | $18.63 |
| J1327 | A | $31.02 |
| J1330 | A | $91.15 |
| J1364 | A | $48.40 |
| J1410 | A | $228.37 |
| J1430 | A | $404.09 |
| J1438 | A | $352.11 |
| J1439 | A | $1.06 |
| J1442 | A | $1.01 |
| J1447 | A | $0.77 |
| J1451 | A | $7.38 |
| J1453 | A | $1.73 |
| J1458 | A | $364.39 |
| J1459 | A | $38.26 |
| J1556 | A | $38.86 |
| J1557 | A | $37.31 |
| J1559 | A | $8.47 |
| J1561 | A | $41.77 |
| J1566 | A | $34.90 |
| J1568 | A | $42.44 |
| J1569 | A | $38.12 |
| J1571 | A | $55.81 |
| J1572 | A | $39.36 |
| J1573 | A | $55.81 |
| J1575 | A | $10.83 |
| J1595 | A | $190.45 |
| J1602 | A | $24.36 |
| J1610 | A | $197.95 |
| J1640 | A | $21.77 |
| J1670 | A | $402.82 |
| J1725 | A | $2.59 |
| J1740 | A | $108.35 |
| J1742 | A | $94.25 |
| J1743 | A | $519.72 |
| J1744 | A | $312.44 |
| J1745 | A | $79.91 |
| J1750 | A | $12.20 |
| J1786 | A | $42.00 |
| J1830 | A | $363.65 |
| J1833 | A | $0.63 |
| J1930 | A | $48.17 |
| J1931 | A | $29.45 |
| J1945 | A | $235.52 |
| J1950 | A | $928.95 |
| J2020 | A | $23.71 |
| J2278 | A | $7.18 |
| J2315 | A | $3.18 |
| J2320 | A | $122.78 |
| J2323 | A | $17.02 |
| J2325 | A | $73.14 |
| J2353 | A | $158.71 |
| J2355 | A | $439.06 |
| J2357 | A | $29.97 |
| J2358 | A | $2.92 |
| J2407 | A | $25.62 |
| J2425 | A | $16.41 |
| J2426 | A | $8.69 |
| J2469 | A | $21.47 |
| J2502 | A | $279.63 |
| J2503 | A | $1,036.15 |
| J2504 | A | $281.40 |
| J2505 | A | $3,828.10 |
| J2507 | A | $1,363.40 |
| J2510 | A | $22.52 |
| J2547 | A | $1.68 |
| J2562 | A | $307.88 |
| J2597 | A | $13.52 |
| J2670 | A | $1,600.40 |
| J2724 | A | $15.13 |
| J2760 | A | $159.00 |
| J2770 | A | $332.13 |
| J2778 | A | $387.66 |
| J2783 | A | $231.87 |
| J2792 | A | $20.22 |
| J2793 | A | $24.09 |
| J2794 | A | $7.28 |
| J2796 | A | $59.11 |
| J2800 | A | $43.22 |
| J2820 | A | $34.28 |
| J2850 | A | $34.78 |
| J2860 | A | $9.00 |
| J2941 | A | $81.59 |
| J2993 | A | $2,301.91 |
| J2997 | A | $74.69 |
| J3060 | A | $38.56 |
| J3070 | A | $123.97 |
| J3090 | A | $1.21 |
| J3095 | A | $5.30 |
| J3101 | A | $93.93 |
| J3145 | A | $1.17 |
| J3240 | A | $1,431.97 |
| J3243 | A | $2.43 |
| J3246 | A | $9.14 |
| J3262 | A | $4.00 |
| J3285 | A | $61.24 |
| J3300 | A | $3.75 |
| J3315 | A | $238.97 |
| J3355 | A | $62.98 |
| J3357 | A | $170.98 |
| J3365 | A | $262.79 |
| J3380 | A | $17.03 |
| J3385 | A | $342.86 |
| J3396 | A | $10.98 |
| J3465 | A | $3.88 |
| J3489 | A | $27.53 |
| J7178 | A | $1.09 |
| J7180 | A | $7.77 |
| J7181 | A | $14.03 |
| J7183 | A | $1.00 |
| J7185 | A | $1.22 |
| J7186 | A | $0.97 |
| J7187 | A | $1.00 |
| J7188 | A | $4.76 |
| J7189 | A | $1.97 |
| J7190 | A | $0.96 |
| J7191 | A | $0.20 |
| J7192 | A | $1.18 |
| J7193 | A | $1.10 |
| J7194 | A | $1.22 |
| J7195 | A | $1.45 |
| J7196 | A | $103.35 |
| J7197 | A | $3.62 |
| J7198 | A | $1.90 |
| J7200 | A | $1.24 |
| J7201 | A | $2.81 |
| J7205 | A | $1.89 |
| J7308 | A | $292.56 |
| J7309 | A | $83.69 |
| J7310 | A | $16,960.00 |
| J7311 | A | $20,150.53 |
| J7312 | A | $201.12 |
| J7313 | A | $490.95 |
| J7316 | A | $1,046.75 |
| J7321 | A | $88.12 |
| J7323 | A | $149.10 |
| J7324 | A | $168.54 |
| J7325 | A | $13.13 |
| J7326 | A | $563.61 |
| J7327 | A | $935.00 |
| J7336 | A | $2.89 |
| J7340 | A | $2.14 |
| J7501 | A | $217.30 |
| J7504 | A | $1,136.93 |
| J7508 | A | $0.39 |
| J7511 | A | $643.00 |
| J7513 | A | $526.34 |
| J7525 | A | $164.44 |
| J8501 | A | $10.20 |
| J8510 | A | $12.34 |
| J8520 | A | $5.24 |
| J8521 | A | $16.65 |
| J8560 | A | $68.62 |
| J8650 | A | $34.10 |
| J8655 | A | $494.08 |
| J8700 | A | $3.62 |
| J8705 | A | $101.16 |
| J9015 | A | $2,667.51 |
| J9017 | A | $59.26 |
| J9019 | A | $388.69 |
| J9025 | A | $2.99 |
| J9027 | A | $138.32 |
| J9031 | A | $123.76 |
| J9032 | A | $32.50 |
| J9033 | A | $24.59 |
| J9035 | A | $70.84 |
| J9039 | A | $95.41 |
| J9041 | A | $46.82 |
| J9042 | A | $124.42 |
| J9043 | A | $147.72 |
| J9047 | A | $30.88 |
| J9050 | A | $3,217.51 |
| J9055 | A | $53.81 |
| J9065 | A | $17.54 |
| J9070 | A | $48.67 |
| J9098 | A | $581.35 |
| J9120 | A | $1,160.34 |
| J9150 | A | $26.46 |
| J9151 | A | $238.86 |
| J9155 | A | $3.65 |
| J9171 | A | $2.60 |
| J9179 | A | $104.43 |
| J9200 | A | $69.59 |
| J9202 | A | $276.66 |
| J9207 | A | $73.47 |
| J9208 | A | $30.94 |
| J9211 | A | $39.05 |
| J9213 | A | $733.57 |
| J9214 | A | $23.90 |
| J9216 | A | $5,265.95 |
| J9217 | A | $252.59 |
| J9219 | A | $168.48 |
| J9225 | A | $3,007.40 |
| J9226 | A | $23,788.39 |
| J9228 | A | $139.26 |
| J9230 | A | $241.71 |
| J9245 | A | $1,604.05 |
| J9261 | A | $148.12 |
| J9262 | A | $2.50 |
| J9263 | A | $0.39 |
| J9264 | A | $10.03 |
| J9266 | A | $8,957.17 |
| J9268 | A | $1,620.74 |
| J9271 | A | $45.70 |
| J9280 | A | $107.60 |
| J9293 | A | $27.37 |
| J9299 | A | $25.37 |
| J9301 | A | $55.36 |
| J9302 | A | $50.53 |
| J9303 | A | $103.39 |
| J9305 | A | $61.76 |
| J9306 | A | $10.47 |
| J9307 | A | $221.75 |
| J9308 | A | $54.02 |
| J9310 | A | $769.01 |
| J9315 | A | $299.30 |
| J9320 | A | $320.01 |
| J9328 | A | $6.74 |
| J9330 | A | $63.74 |
| J9340 | A | $1,286.59 |
| J9354 | A | $29.21 |
| J9355 | A | $89.51 |
| J9357 | A | $1,114.16 |
| J9371 | A | $2,320.19 |
| J9395 | A | $93.58 |
| J9400 | A | $8.21 |
| J9600 | A | $20,602.26 |
| P9041 | A | $10.91 |
| P9045 | A | $54.54 |
| P9046 | A | $22.49 |
| P9047 | A | $53.44 |
| Q0138 | A | $0.82 |
| Q2017 | A | $2,025.66 |
| Q2043 | A | $36,413.47 |
| Q2049 | A | $508.43 |
| Q2050 | A | $431.52 |
| Q3027 | A | $41.79 |
| Q4121 | A | $38.47 |
| Q5101 | A | $0.97 |
| Q9950 | A | $33.06 |
| Q9968 | A | $10.64 |
| 90371 | A | $113.22 |
| 90375 | A | $285.18 |
| 90376 | A | $262.81 |
| 90378 | A | $1,947.49 |
| 90396 | A | $1,230.98 |
| 90585 | A | $123.76 |
| 90620 | A | $156.60 |
| 90621 | A | $122.70 |
| 90675 | A | $280.21 |
| 90676 | A | $172.30 |
| 90733 | A | $106.49 |
| 90734 | A | $107.16 |
| 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 2016 by the American Medical Association.

