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Revised October 2016 4th QTR ASC Drug File

Effective 10.01.2016

Revised: 10.01.17

HCPCS Code Status Indicator Amount
A9586 A $2,756.00
C9121 A $10.70
C9132 A $1.77
C9137 A $1.55
C9138 A $1.50
C9139 A $4.18
C9248 A $2.89
C9257 A $1.81
C9293 A $284.27
C9349 A $119.12
C9399 C $0.00
C9447 A $487.12
C9460 A $15.48
C9461 A $5,700.00
C9470 A $2.37
C9471 A $16.41
C9472 A $46.28
C9473 A $25.93
C9474 A $39.55
C9475 A $5.28
C9476 A $46.85
C9477 A $6.25
C9478 A $530.00
C9479 A $30.00
C9480 A $283.34
C9481 A $8.85
C9482 A $9.99
C9483 A $76.14
C9497 A $153.70
J0120 A $97.97
J0129 A $44.75
J0132 A $1.51
J0135 A $861.45
J0178 A $980.46
J0180 A $164.42
J0202 A $1,738.36
J0207 A $416.53
J0215 A $41.64
J0220 A $206.70
J0221 A $159.39
J0256 A $4.83
J0257 A $4.37
J0287 A $13.41
J0289 A $19.01
J0300 A $194.26
J0401 A $4.38
J0475 A $173.43
J0476 A $76.96
J0480 A $3,196.11
J0485 A $3.84
J0490 A $42.02
J0561 A $10.31
J0585 A $5.93
J0586 A $7.90
J0587 A $11.71
J0588 A $4.91
J0594 A $38.37
J0596 A $27.95
J0597 A $46.52
J0598 A $55.55
J0600 A $5,594.42
J0630 A $2,321.14
J0637 A $12.21
J0638 A $92.49
J0641 A $0.90
J0695 A $4.54
J0712 A $2.48
J0714 A $77.05
J0716 A $4,246.69
J0717 A $7.11
J0720 A $40.36
J0725 A $24.62
J0740 A $554.48
J0775 A $41.42
J0795 A $8.12
J0800 A $3,555.35
J0833 A $101.68
J0840 A $2,670.24
J0850 A $1,126.55
J0875 A $15.22
J0878 A $0.90
J0881 A $3.93
J0885 A $12.59
J0887 A $1.48
J0894 A $20.83
J0897 A $16.23
J1160 A $4.82
J1162 A $3,039.53
J1190 A $184.05
J1205 A $86.68
J1212 A $481.94
J1290 A $399.56
J1300 A $221.12
J1322 A $221.77
J1324 A $18.63
J1327 A $31.29
J1330 A $91.15
J1364 A $59.29
J1410 A $261.40
J1430 A $404.09
J1438 A $404.62
J1439 A $1.05
J1442 A $1.00
J1447 A $0.74
J1451 A $7.94
J1453 A $1.89
J1458 A $364.41
J1459 A $37.90
J1556 A $39.52
J1557 A $37.03
J1559 A $9.83
J1561 A $38.58
J1566 A $33.07
J1568 A $35.98
J1569 A $40.00
J1571 A $56.06
J1572 A $36.80
J1573 A $56.06
J1575 A $12.74
J1595 A $198.58
J1602 A $24.79
J1610 A $199.12
J1640 A $22.86
J1670 A $433.06
J1725 A $2.69
J1740 A $101.96
J1742 A $186.19
J1743 A $522.04
J1744 A $325.48
J1745 A $82.87
J1750 A $12.41
J1786 A $41.93
J1830 A $390.11
J1833 A $0.64
J1930 A $51.31
J1931 A $30.59
J1945 A $235.52
J1950 A $1,038.70
J2020 A $15.78
J2278 A $7.31
J2315 A $3.24
J2320 A $122.78
J2323 A $17.89
J2325 A $72.73
J2353 A $168.11
J2355 A $467.22
J2357 A $32.31
J2358 A $2.92
J2407 A $24.64
J2425 A $17.68
J2426 A $9.12
J2469 A $22.88
J2502 A $265.36
J2503 A $1,054.70
J2504 A $319.67
J2505 A $4,040.69
J2507 A $1,642.46
J2510 A $26.77
J2547 A $1.65
J2562 A $312.11
J2597 A $14.04
J2670 A $1,600.40
J2724 A $15.23
J2760 A $402.51
J2770 A $413.52
J2778 A $383.23
J2783 A $254.11
J2792 A $21.33
J2793 A $24.09
J2794 A $7.82
J2796 A $62.14
J2800 A $38.57
J2820 A $36.23
J2850 A $34.78
J2860 A $9.00
J2941 A $81.59
J2993 A $2,301.91
J2997 A $80.29
J3060 A $40.46
J3070 A $140.39
J3090 A $1.28
J3095 A $5.02
J3101 A $102.43
J3145 A $1.22
J3240 A $1,571.30
J3243 A $3.13
J3246 A $9.00
J3262 A $4.10
J3285 A $61.24
J3300 A $3.70
J3315 A $460.85
J3355 A $132.66
J3357 A $174.57
J3365 A $262.79
J3380 A $17.43
J3385 A $343.35
J3396 A $10.88
J3465 A $4.64
J3489 A $15.67
J7178 A $1.14
J7180 A $8.18
J7181 A $14.62
J7183 A $0.97
J7185 A $1.20
J7186 A $0.97
J7187 A $1.04
J7188 A $4.53
J7189 A $1.90
J7190 A $0.98
J7191 A $0.20
J7192 A $1.20
J7193 A $1.11
J7194 A $1.29
J7195 A $1.52
J7196 A $103.35
J7197 A $3.43
J7198 A $1.92
J7200 A $1.25
J7201 A $2.82
J7205 A $1.89
J7308 A $327.41
J7309 A $83.69
J7310 A $16,960.00
J7311 A $20,126.60
J7312 A $200.90
J7313 A $490.95
J7316 A $1,046.75
J7321 A $87.73
J7323 A $155.32
J7324 A $159.28
J7325 A $12.77
J7326 A $587.58
J7327 A $917.77
J7336 A $2.98
J7340 A $2.14
J7501 A $255.53
J7503 A $1.23
J7504 A $1,438.74
J7508 A $0.39
J7511 A $690.84
J7513 A $526.34
J7525 A $163.77
J8501 A $11.11
J8510 A $23.69
J8520 A $4.12
J8521 A $13.78
J8560 A $71.61
J8650 A $38.19
J8655 A $461.97
J8700 A $2.66
J8705 A $103.85
J9015 A $3,067.64
J9017 A $64.62
J9019 A $402.74
J9025 A $2.84
J9027 A $152.44
J9031 A $123.20
J9032 A $33.54
J9033 A $27.01
J9035 A $72.31
J9039 A $98.79
J9041 A $46.52
J9042 A $129.09
J9043 A $154.57
J9047 A $31.95
J9050 A $3,847.56
J9055 A $55.63
J9065 A $21.75
J9070 A $43.97
J9098 A $595.76
J9120 A $1,276.38
J9150 A $40.03
J9151 A $243.67
J9155 A $3.62
J9171 A $2.72
J9179 A $106.08
J9200 A $52.80
J9202 A $327.12
J9207 A $77.87
J9208 A $28.18
J9211 A $29.76
J9213 A $733.57
J9214 A $26.86
J9216 A $5,739.88
J9217 A $225.01
J9219 A $168.48
J9225 A $3,138.04
J9226 A $26,205.50
J9228 A $142.65
J9230 A $265.89
J9245 A $1,871.63
J9261 A $152.21
J9262 A $2.69
J9263 A $0.39
J9264 A $10.32
J9266 A $13,911.23
J9268 A $1,887.77
J9271 A $46.50
J9280 A $103.17
J9293 A $36.75
J9299 A $26.06
J9301 A $56.20
J9302 A $51.87
J9303 A $105.60
J9305 A $62.78
J9306 A $10.65
J9307 A $229.72
J9308 A $55.93
J9310 A $792.92
J9315 A $306.79
J9320 A $323.60
J9328 A $8.24
J9330 A $66.67
J9340 A $1,035.21
J9354 A $29.22
J9355 A $92.09
J9357 A $1,148.73
J9371 A $2,506.49
J9395 A $95.77
J9400 A $8.45
J9600 A $20,910.92
P9041 A $11.02
P9045 A $54.72
P9046 A $22.49
P9047 A $53.44
Q0138 A $0.88
Q2017 A $2,377.68
Q2043 A $38,034.65
Q2049 A $508.43
Q2050 A $435.44
Q3027 A $45.37
Q4121 A $42.71
Q5101 A $0.83
Q9950 A $22.33
Q9968 A $2.22
Q9981 A $12.65
Q9982 A $3,135.00
Q9983 A $2,968.00
90371 A $111.33
90375 A $305.48
90376 A $294.59
90378 A $1,947.49
90396 A $1,230.98
90585 A $123.20
90620 A $147.37
90621 A $122.70
90675 A $272.49
90676 A $172.30
90733 A $106.49
90734 A $97.49
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 2017 by the
American Medical Association.

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 2017 by the American Medical Association.

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