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Revised: April 2016 2nd QTR ASC Drug File

Revised: 09.28.16

Effective: 04.01.2016

HCPCS Code Status Indicator Amount
A9586 A $2,756.00
C9121 A $12.40
C9132 A $1.69
C9137 A $1.89
C9138 A $1.99
C9248 A $2.37
C9257 A $1.77
C9293 A $270.72
C9349 A $121.38
C9399 C $0.00
C9447 A $487.89
C9458 A $2,968.00
C9459 A $3,135.00
C9460 A $15.53
C9461 A $5,700.00
C9470 A $2.53
C9471 A $19.00
C9472 A $46.64
C9473 A $26.50
C9474 A $39.93
C9475 A $5.30
C9497 A $144.70
J0120 A $97.97
J0129 A $41.05
J0132 A $1.63
J0135 A $796.67
J0178 A $980.50
J0180 A $159.66
J0202 A $1,738.69
J0207 A $390.34
J0215 A $41.64
J0220 A $206.70
J0221 A $154.62
J0256 A $4.60
J0257 A $4.27
J0287 A $13.75
J0289 A $18.04
J0300 A $194.26
J0401 A $4.25
J0475 A $182.76
J0476 A $77.36
J0480 A $3,039.87
J0485 A $3.80
J0490 A $41.49
J0561 A $8.38
J0585 A $5.72
J0586 A $7.77
J0587 A $11.67
J0588 A $4.82
J0594 A $33.16
J0596 A $26.75
J0597 A $46.32
J0598 A $54.51
J0600 A $5,594.42
J0630 A $2,369.13
J0637 A $13.26
J0638 A $92.40
J0641 A $1.41
J0695 A $4.29
J0712 A $2.31
J0714 A $73.90
J0716 A $3,926.66
J0717 A $6.49
J0720 A $31.74
J0725 A $16.22
J0740 A $594.16
J0775 A $38.50
J0795 A $7.71
J0800 A $3,578.55
J0833 A $101.68
J0840 A $2,670.39
J0850 A $1,064.77
J0875 A $14.70
J0878 A $0.83
J0881 A $4.14
J0885 A $12.37
J0887 A $1.65
J0894 A $22.97
J0897 A $15.61
J1160 A $5.02
J1162 A $3,039.88
J1190 A $163.46
J1205 A $109.09
J1212 A $315.55
J1290 A $400.42
J1300 A $215.92
J1322 A $221.66
J1324 A $18.63
J1327 A $32.51
J1330 A $91.15
J1364 A $49.33
J1410 A $228.37
J1430 A $404.09
J1438 A $379.14
J1439 A $1.06
J1442 A $1.01
J1447 A $0.77
J1451 A $7.00
J1453 A $1.81
J1458 A $364.20
J1459 A $38.26
J1556 A $39.23
J1557 A $37.28
J1559 A $9.84
J1561 A $40.76
J1566 A $33.43
J1568 A $45.86
J1569 A $38.82
J1571 A $54.97
J1572 A $38.13
J1573 A $54.97
J1575 A $11.47
J1595 A $186.37
J1602 A $24.60
J1610 A $196.57
J1640 A $21.77
J1670 A $403.71
J1725 A $2.56
J1740 A $104.13
J1742 A $109.03
J1743 A $522.65
J1744 A $314.28
J1745 A $81.60
J1750 A $12.26
J1786 A $41.96
J1830 A $373.58
J1833 A $0.63
J1930 A $48.44
J1931 A $29.65
J1945 A $235.52
J1950 A $934.40
J2020 A $17.65
J2278 A $7.18
J2315 A $3.20
J2320 A $122.78
J2323 A $17.06
J2325 A $73.21
J2353 A $160.40
J2355 A $439.87
J2357 A $31.13
J2358 A $2.92
J2407 A $24.70
J2425 A $16.38
J2426 A $8.68
J2469 A $22.27
J2502 A $239.45
J2503 A $1,054.70
J2504 A $281.40
J2505 A $3,896.81
J2507 A $1,379.99
J2510 A $22.99
J2547 A $1.65
J2562 A $308.16
J2597 A $14.11
J2670 A $1,600.40
J2724 A $15.19
J2760 A $425.79
J2770 A $332.14
J2778 A $386.33
J2783 A $241.95
J2792 A $20.25
J2793 A $24.09
J2794 A $7.32
J2796 A $59.73
J2800 A $40.50
J2820 A $35.12
J2850 A $34.78
J2860 A $9.00
J2941 A $81.59
J2993 A $2,301.91
J2997 A $74.66
J3060 A $38.56
J3070 A $125.46
J3090 A $1.21
J3095 A $5.22
J3101 A $93.98
J3145 A $1.19
J3240 A $1,457.99
J3243 A $2.42
J3246 A $9.82
J3262 A $3.98
J3285 A $61.24
J3300 A $3.71
J3315 A $234.96
J3355 A $120.61
J3357 A $169.34
J3365 A $262.79
J3380 A $17.03
J3385 A $342.29
J3396 A $10.96
J3465 A $4.56
J3489 A $21.12
J7178 A $1.09
J7180 A $7.77
J7181 A $13.77
J7183 A $0.98
J7185 A $1.20
J7186 A $0.97
J7187 A $1.00
J7188 A $4.37
J7189 A $1.90
J7190 A $0.96
J7191 A $0.20
J7192 A $1.18
J7193 A $1.12
J7194 A $1.22
J7195 A $1.45
J7196 A $103.35
J7197 A $3.68
J7198 A $1.90
J7200 A $1.23
J7201 A $2.82
J7205 A $1.90
J7308 A $327.41
J7309 A $83.69
J7310 A $16,960.00
J7311 A $20,136.40
J7312 A $201.11
J7313 A $490.95
J7316 A $1,046.75
J7321 A $88.56
J7323 A $156.86
J7324 A $167.83
J7325 A $12.83
J7326 A $571.96
J7327 A $934.44
J7336 A $2.89
J7340 A $2.14
J7501 A $217.30
J7503 A $1.03
J7504 A $1,137.19
J7508 A $0.39
J7511 A $649.58
J7513 A $526.34
J7525 A $164.16
J8501 A $10.03
J8510 A $16.02
J8520 A $4.89
J8521 A $15.63
J8560 A $67.30
J8650 A $38.19
J8655 A $395.65
J8700 A $3.58
J8705 A $101.04
J9015 A $2,667.51
J9017 A $59.24
J9019 A $391.01
J9025 A $2.94
J9027 A $138.21
J9031 A $122.99
J9032 A $32.41
J9033 A $24.63
J9035 A $70.96
J9039 A $95.10
J9041 A $46.82
J9042 A $124.24
J9043 A $150.25
J9047 A $32.09
J9050 A $3,860.63
J9055 A $54.37
J9065 A $21.85
J9070 A $43.51
J9098 A $576.26
J9120 A $1,160.34
J9150 A $39.17
J9151 A $238.83
J9155 A $3.68
J9171 A $2.39
J9179 A $104.78
J9200 A $47.45
J9202 A $282.90
J9207 A $73.85
J9208 A $29.78
J9211 A $36.95
J9213 A $733.57
J9214 A $25.30
J9216 A $5,739.88
J9217 A $231.79
J9219 A $168.48
J9225 A $3,052.96
J9226 A $24,068.75
J9228 A $140.75
J9230 A $241.71
J9245 A $1,884.07
J9261 A $147.94
J9262 A $2.58
J9263 A $0.37
J9264 A $10.00
J9266 A $14,275.20
J9268 A $1,630.95
J9271 A $45.70
J9280 A $102.51
J9293 A $33.59
J9299 A $25.62
J9301 A $55.20
J9302 A $50.61
J9303 A $103.97
J9305 A $61.68
J9306 A $10.44
J9307 A $221.07
J9308 A $54.00
J9310 A $769.89
J9315 A $298.21
J9320 A $314.59
J9328 A $7.33
J9330 A $63.74
J9340 A $1,145.19
J9354 A $29.22
J9355 A $89.67
J9357 A $1,134.35
J9371 A $2,412.47
J9395 A $94.02
J9400 A $8.06
J9600 A $20,602.26
P9041 A $11.32
P9045 A $54.72
P9046 A $22.49
P9047 A $53.44
Q0138 A $0.84
Q2017 A $2,025.66
Q2043 A $38,347.31
Q2049 A $508.43
Q2050 A $435.93
Q3027 A $43.48
Q4121 A $39.64
Q5101 A $0.97
Q5102 A $0.00
Q9950 A $24.16
Q9968 A $11.41
90371 A $121.92
90375 A $289.83
90376 A $279.13
90378 A $1,947.49
90396 A $1,230.98
90585 A $122.99
90620 A $153.09
90621 A $122.70
90675 A $273.97
90676 A $172.30
90733 A $106.49
90734 A $105.99
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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