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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.

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