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Revised April 2017 2nd QTR ASC Drug File

Effective: 04.01.2017

Revised: 10.01.17

HCPCS Code Status Indicator Amount
A9515 A $5,700.00
A9586 A $2,756.00
A9587 A $66.74
A9588 A $389.55
C9132 A $1.85
C9140 A $1.42
C9248 A $2.09
C9250 A $111.68
C9257 A $1.84
C9293 A $284.22
C9399 C $0.00
C9447 A $487.86
C9460 A $15.37
C9482 A $9.99
C9483 A $75.62
C9484 A $169.60
C9485 A $50.03
C9486 A $5.25
C9487 A $12.78
C9488 A $29.93
C9497 A $150.04
J0120 A $7.29
J0129 A $46.86
J0130 A $1,152.19
J0135 A $1,176.93
J0178 A $980.14
J0180 A $166.06
J0202 A $1,753.02
J0207 A $519.01
J0215 A $41.64
J0220 A $206.70
J0221 A $159.74
J0256 A $4.82
J0257 A $4.36
J0287 A $13.18
J0289 A $19.53
J0300 A $194.26
J0401 A $4.58
J0475 A $168.69
J0476 A $76.84
J0480 A $3,357.34
J0485 A $3.83
J0490 A $42.58
J0561 A $10.75
J0570 A $1,260.59
J0583 A $1.48
J0585 A $5.94
J0586 A $7.97
J0587 A $11.75
J0588 A $4.93
J0594 A $36.50
J0596 A $27.94
J0597 A $48.70
J0598 A $55.53
J0600 A $5,594.42
J0630 A $2,267.89
J0637 A $10.56
J0638 A $92.51
J0641 A $0.71
J0695 A $4.74
J0712 A $2.47
J0714 A $77.13
J0716 A $4,246.69
J0717 A $7.39
J0740 A $522.12
J0775 A $40.69
J0795 A $8.12
J0800 A $3,537.09
J0840 A $2,869.92
J0850 A $1,127.74
J0875 A $14.73
J0878 A $0.68
J0881 A $3.85
J0882 A $3.85
J0883 A $1.62
J0885 A $13.62
J0894 A $17.96
J0897 A $16.63
J1130 A $0.16
J1162 A $3,267.54
J1190 A $206.33
J1205 A $77.90
J1212 A $533.72
J1290 A $421.62
J1300 A $226.63
J1322 A $224.37
J1324 A $18.63
J1327 A $23.61
J1364 A $59.44
J1410 A $278.39
J1430 A $422.37
J1438 A $437.58
J1439 A $1.06
J1442 A $1.01
J1447 A $0.67
J1451 A $7.78
J1453 A $1.94
J1455 A $75.17
J1458 A $369.42
J1459 A $38.87
J1460 A $35.74
J1556 A $38.31
J1557 A $41.62
J1559 A $9.83
J1560 A $357.38
J1561 A $33.93
J1566 A $32.64
J1568 A $36.09
J1569 A $40.43
J1571 A $58.65
J1572 A $30.18
J1573 A $58.65
J1575 A $12.96
J1595 A $197.90
J1602 A $24.99
J1610 A $200.82
J1640 A $22.86
J1670 A $365.15
J1725 A $2.74
J1730 A $690.03
J1740 A $78.29
J1742 A $192.50
J1743 A $522.01
J1744 A $325.61
J1745 A $85.59
J1750 A $12.46
J1786 A $41.80
J1826 A $482.21
J1830 A $376.30
J1833 A $0.63
J1930 A $54.01
J1931 A $30.61
J1942 A $2.39
J1945 A $12.71
J1950 A $1,024.55
J2182 A $26.65
J2260 A $2.48
J2265 A $1.51
J2278 A $7.33
J2315 A $3.25
J2320 A $133.36
J2323 A $18.80
J2325 A $73.18
J2353 A $175.55
J2355 A $467.22
J2357 A $33.61
J2358 A $2.92
J2407 A $23.59
J2425 A $17.68
J2426 A $9.50
J2469 A $22.63
J2502 A $260.76
J2503 A $1,054.70
J2504 A $345.23
J2505 A $4,191.34
J2507 A $1,821.53
J2510 A $26.77
J2515 A $47.34
J2547 A $1.62
J2562 A $312.10
J2597 A $13.15
J2670 A $1,600.40
J2724 A $15.20
J2730 A $87.04
J2760 A $334.92
J2770 A $436.77
J2778 A $375.21
J2783 A $259.15
J2786 A $8.85
J2792 A $22.70
J2793 A $24.09
J2794 A $8.17
J2796 A $65.03
J2820 A $37.09
J2840 A $530.00
J2850 A $34.78
J2860 A $90.02
J2941 A $81.59
J2993 A $2,301.91
J2997 A $81.35
J3060 A $40.40
J3070 A $136.71
J3090 A $1.27
J3095 A $5.00
J3101 A $102.42
J3240 A $1,566.93
J3243 A $3.18
J3246 A $9.81
J3262 A $4.22
J3285 A $61.24
J3300 A $3.74
J3315 A $365.44
J3355 A $132.66
J3357 A $174.20
J3365 A $262.79
J3380 A $18.13
J3385 A $342.70
J3396 A $10.76
J3465 A $3.64
J7175 A $6.52
J7178 A $1.15
J7179 A $2.27
J7180 A $8.19
J7181 A $14.74
J7182 A $1.29
J7183 A $1.01
J7185 A $1.22
J7186 A $0.99
J7187 A $1.09
J7188 A $3.96
J7189 A $1.93
J7190 A $1.01
J7191 A $0.20
J7192 A $1.20
J7193 A $1.16
J7194 A $1.34
J7195 A $1.51
J7196 A $103.35
J7197 A $3.22
J7198 A $1.93
J7200 A $1.25
J7201 A $2.93
J7202 A $4.15
J7205 A $1.98
J7207 A $1.71
J7209 A $1.63
J7308 A $367.81
J7309 A $83.69
J7310 A $11.71
J7311 A $20,110.39
J7312 A $200.78
J7313 A $490.95
J7316 A $1,046.75
J7321 A $87.16
J7322 A $16.76
J7323 A $153.84
J7324 A $153.55
J7325 A $12.54
J7326 A $543.61
J7327 A $895.15
J7328 A $2.18
J7340 A $2.24
J7342 A $29.95
J7501 A $250.45
J7503 A $1.23
J7504 A $1,478.80
J7505 A $231.22
J7511 A $687.77
J7513 A $10.00
J7525 A $170.85
J8501 A $11.78
J8510 A $23.67
J8560 A $74.25
J8650 A $38.20
J8655 A $444.91
J8670 A $2.15
J8700 A $1.86
J8705 A $103.79
J9015 A $3,067.64
J9017 A $64.93
J9019 A $402.74
J9025 A $2.11
J9027 A $152.37
J9031 A $128.38
J9032 A $34.39
J9033 A $27.97
J9034 A $23.46
J9035 A $73.60
J9039 A $98.83
J9041 A $46.25
J9042 A $134.15
J9043 A $156.66
J9047 A $32.20
J9050 A $3,846.96
J9055 A $56.39
J9065 A $20.03
J9070 A $42.31
J9098 A $593.99
J9120 A $1,276.38
J9145 A $48.11
J9150 A $39.24
J9151 A $243.80
J9155 A $3.63
J9171 A $1.89
J9176 A $6.21
J9179 A $108.31
J9200 A $60.59
J9202 A $349.92
J9205 A $39.48
J9207 A $75.36
J9208 A $28.07
J9211 A $41.54
J9213 A $32.23
J9214 A $28.52
J9216 A $6,308.13
J9217 A $216.01
J9218 A $25.96
J9219 A $168.48
J9225 A $3,128.81
J9226 A $27,736.93
J9228 A $144.66
J9230 A $265.89
J9245 A $1,804.13
J9261 A $152.03
J9262 A $2.72
J9263 A $0.27
J9264 A $10.45
J9266 A $13,912.20
J9268 A $1,883.12
J9271 A $47.30
J9280 A $115.68
J9293 A $32.85
J9295 A $5.25
J9299 A $26.43
J9301 A $57.36
J9302 A $53.39
J9303 A $107.71
J9305 A $64.04
J9306 A $10.88
J9307 A $238.68
J9308 A $56.27
J9310 A $818.31
J9315 A $317.58
J9320 A $320.21
J9325 A $46.04
J9328 A $8.95
J9330 A $67.30
J9340 A $872.14
J9351 A $1.26
J9352 A $283.44
J9354 A $29.52
J9355 A $94.49
J9357 A $1,158.11
J9371 A $2,600.36
J9395 A $96.24
J9400 A $8.12
J9600 A $21,219.57
P9041 A $11.80
P9045 A $54.72
P9046 A $22.49
P9047 A $53.44
Q0138 A $0.89
Q0139 A $0.89
Q2017 A $2,592.79
Q2043 A $39,919.01
Q2049 A $508.43
Q2050 A $408.15
Q3027 A $46.21
Q4172 A $120.20
Q5101 A $0.76
Q5102 A $100.31
Q9950 A $21.61
Q9968 A $2.97
Q9982 A $3,498.00
Q9983 A $2,968.00
90371 A $111.96
90375 A $296.71
90376 A $296.34
90378 A $176.35
90396 A $1,230.98
90675 A $269.91
90676 A $141.02
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 theĀ American Medical Association.

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