July 2017 3rd QTR ASC Drug File
Effective: 07.01.2017
Revised: 01.01.18
| 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 | $2.19 |
| C9250 | A | $112.92 |
| C9257 | A | $1.87 |
| C9293 | A | $284.08 |
| C9399 | C | $0.00 |
| C9447 | A | $483.34 |
| C9460 | A | $15.30 |
| C9482 | A | $9.99 |
| C9483 | A | $75.60 |
| C9484 | A | $169.60 |
| C9485 | A | $49.95 |
| C9486 | A | $5.15 |
| C9488 | A | $30.30 |
| C9489 | A | $1,104.17 |
| C9490 | A | $40.28 |
| C9497 | A | $153.70 |
| J0120 | A | $7.29 |
| J0129 | A | $47.61 |
| J0130 | A | $1,235.47 |
| J0135 | A | $1,176.93 |
| J0178 | A | $978.09 |
| J0180 | A | $170.99 |
| J0202 | A | $1,781.99 |
| J0207 | A | $1,034.13 |
| J0215 | A | $41.64 |
| J0220 | A | $206.70 |
| J0221 | A | $159.74 |
| J0256 | A | $4.94 |
| J0257 | A | $4.63 |
| J0287 | A | $13.08 |
| J0289 | A | $20.75 |
| J0300 | A | $194.26 |
| J0401 | A | $4.79 |
| J0475 | A | $168.01 |
| J0476 | A | $73.21 |
| J0480 | A | $3,423.97 |
| J0485 | A | $3.91 |
| J0490 | A | $41.98 |
| J0561 | A | $11.45 |
| J0570 | A | $1,274.04 |
| J0583 | A | $1.51 |
| J0585 | A | $5.99 |
| J0586 | A | $7.95 |
| J0587 | A | $11.91 |
| J0588 | A | $5.08 |
| J0594 | A | $35.86 |
| J0596 | A | $27.97 |
| J0597 | A | $48.90 |
| J0598 | A | $56.42 |
| J0600 | A | $5,594.42 |
| J0630 | A | $2,282.99 |
| J0637 | A | $11.98 |
| J0638 | A | $92.51 |
| J0641 | A | $0.70 |
| J0695 | A | $4.96 |
| J0712 | A | $2.62 |
| J0714 | A | $77.00 |
| J0716 | A | $4,459.02 |
| J0717 | A | $7.71 |
| J0740 | A | $488.40 |
| J0775 | A | $40.66 |
| J0795 | A | $8.25 |
| J0800 | A | $3,703.38 |
| J0840 | A | $2,870.72 |
| J0850 | A | $1,128.67 |
| J0875 | A | $14.57 |
| J0878 | A | $0.67 |
| J0881 | A | $3.90 |
| J0882 | A | $3.90 |
| J0883 | A | $1.51 |
| J0885 | A | $13.76 |
| J0894 | A | $19.35 |
| J0897 | A | $17.04 |
| J1130 | A | $0.18 |
| J1162 | A | $3,267.03 |
| J1190 | A | $184.66 |
| J1205 | A | $66.42 |
| J1212 | A | $553.42 |
| J1290 | A | $432.71 |
| J1300 | A | $226.63 |
| J1322 | A | $227.10 |
| J1324 | A | $18.63 |
| J1327 | A | $21.84 |
| J1364 | A | $62.43 |
| J1410 | A | $303.16 |
| J1430 | A | $444.10 |
| J1438 | A | $457.26 |
| J1439 | A | $1.07 |
| J1442 | A | $1.01 |
| J1447 | A | $0.64 |
| J1451 | A | $6.89 |
| J1453 | A | $1.91 |
| J1455 | A | $75.17 |
| J1458 | A | $373.81 |
| J1459 | A | $38.60 |
| J1460 | A | $36.37 |
| J1556 | A | $38.31 |
| J1557 | A | $46.69 |
| J1559 | A | $9.83 |
| J1560 | A | $363.66 |
| J1561 | A | $38.41 |
| J1566 | A | $32.94 |
| J1568 | A | $34.13 |
| J1569 | A | $40.19 |
| J1571 | A | $60.20 |
| J1572 | A | $27.93 |
| J1573 | A | $60.20 |
| J1575 | A | $13.04 |
| J1595 | A | $214.19 |
| J1602 | A | $24.73 |
| J1610 | A | $194.43 |
| J1640 | A | $23.73 |
| J1670 | A | $422.04 |
| J1730 | A | $690.03 |
| J1740 | A | $83.78 |
| J1742 | A | $65.75 |
| J1743 | A | $533.48 |
| J1744 | A | $329.44 |
| J1745 | A | $85.74 |
| J1750 | A | $13.03 |
| J1786 | A | $41.75 |
| J1826 | A | $482.21 |
| J1830 | A | $391.87 |
| J1833 | A | $0.68 |
| J1930 | A | $54.39 |
| J1931 | A | $30.61 |
| J1942 | A | $2.36 |
| J1945 | A | $12.71 |
| J1950 | A | $1,016.35 |
| J2182 | A | $27.68 |
| J2260 | A | $1.75 |
| J2265 | A | $1.50 |
| J2278 | A | $7.33 |
| J2315 | A | $3.25 |
| J2320 | A | $133.36 |
| J2323 | A | $19.43 |
| J2325 | A | $73.25 |
| J2353 | A | $182.59 |
| J2355 | A | $467.22 |
| J2357 | A | $33.59 |
| J2358 | A | $2.92 |
| J2407 | A | $23.37 |
| J2425 | A | $19.16 |
| J2426 | A | $9.96 |
| J2469 | A | $22.05 |
| J2502 | A | $263.27 |
| J2503 | A | $1,054.70 |
| J2504 | A | $345.23 |
| J2505 | A | $4,247.25 |
| J2507 | A | $1,998.85 |
| J2510 | A | $26.77 |
| J2515 | A | $48.22 |
| J2547 | A | $1.63 |
| J2562 | A | $314.23 |
| J2597 | A | $12.40 |
| J2670 | A | $1,600.40 |
| J2724 | A | $15.17 |
| J2730 | A | $87.94 |
| J2760 | A | $328.88 |
| J2770 | A | $438.30 |
| J2778 | A | $380.89 |
| J2783 | A | $259.25 |
| J2786 | A | $8.85 |
| J2792 | A | $23.86 |
| J2793 | A | $24.09 |
| J2794 | A | $8.54 |
| J2796 | A | $66.58 |
| J2820 | A | $37.82 |
| J2840 | A | $530.00 |
| J2850 | A | $34.78 |
| J2860 | A | $92.56 |
| J2941 | A | $81.59 |
| J2993 | A | $2,301.91 |
| J2997 | A | $83.48 |
| J3060 | A | $40.38 |
| J3070 | A | $74.13 |
| J3090 | A | $1.32 |
| J3095 | A | $5.08 |
| J3101 | A | $110.04 |
| J3240 | A | $1,564.25 |
| J3243 | A | $3.27 |
| J3246 | A | $8.86 |
| J3262 | A | $4.37 |
| J3285 | A | $61.24 |
| J3300 | A | $3.89 |
| J3315 | A | $279.36 |
| J3355 | A | $132.66 |
| J3357 | A | $183.25 |
| J3365 | A | $262.79 |
| J3380 | A | $18.06 |
| J3385 | A | $342.19 |
| J3396 | A | $10.76 |
| J3465 | A | $3.26 |
| J7175 | A | $6.83 |
| J7178 | A | $1.15 |
| J7179 | A | $2.27 |
| J7180 | A | $8.19 |
| J7181 | A | $14.94 |
| J7182 | A | $1.31 |
| J7183 | A | $1.04 |
| J7185 | A | $1.27 |
| J7186 | A | $0.94 |
| J7187 | A | $1.09 |
| J7188 | A | $4.08 |
| J7189 | A | $1.98 |
| J7190 | A | $0.98 |
| J7191 | A | $0.20 |
| J7192 | A | $1.22 |
| J7193 | A | $1.12 |
| J7194 | A | $1.40 |
| J7195 | A | $1.50 |
| J7196 | A | $103.35 |
| J7197 | A | $3.22 |
| J7198 | A | $1.93 |
| J7200 | A | $1.28 |
| J7201 | A | $2.98 |
| J7202 | A | $4.14 |
| J7205 | A | $2.03 |
| J7207 | A | $1.77 |
| J7209 | A | $1.61 |
| J7308 | A | $367.81 |
| J7309 | A | $83.69 |
| J7310 | A | $11.71 |
| J7311 | A | $20,143.25 |
| J7312 | A | $200.76 |
| J7313 | A | $490.95 |
| J7316 | A | $1,046.75 |
| J7321 | A | $85.54 |
| J7322 | A | $16.16 |
| J7323 | A | $152.33 |
| J7324 | A | $142.72 |
| J7325 | A | $12.69 |
| J7326 | A | $558.13 |
| J7327 | A | $867.39 |
| J7328 | A | $2.18 |
| J7340 | A | $2.15 |
| J7342 | A | $29.95 |
| J7501 | A | $246.47 |
| J7503 | A | $1.24 |
| J7504 | A | $1,754.67 |
| J7505 | A | $231.22 |
| J7511 | A | $706.13 |
| J7513 | A | $10.00 |
| J7525 | A | $185.24 |
| J8501 | A | $9.49 |
| J8510 | A | $24.83 |
| J8560 | A | $74.08 |
| J8650 | A | $38.20 |
| J8655 | A | $431.50 |
| J8670 | A | $2.25 |
| J8700 | A | $1.87 |
| J8705 | A | $103.78 |
| J9015 | A | $3,067.64 |
| J9017 | A | $70.94 |
| J9019 | A | $402.74 |
| J9025 | A | $2.10 |
| J9027 | A | $151.96 |
| J9031 | A | $128.68 |
| J9032 | A | $35.26 |
| J9033 | A | $28.91 |
| J9034 | A | $23.55 |
| J9035 | A | $74.84 |
| J9039 | A | $102.30 |
| J9041 | A | $46.84 |
| J9042 | A | $139.75 |
| J9043 | A | $156.92 |
| J9047 | A | $32.14 |
| J9050 | A | $3,862.48 |
| J9055 | A | $57.49 |
| J9065 | A | $21.22 |
| J9070 | A | $42.16 |
| J9098 | A | $611.40 |
| J9120 | A | $1,370.08 |
| J9145 | A | $48.61 |
| J9150 | A | $41.16 |
| J9151 | A | $243.80 |
| J9155 | A | $3.65 |
| J9171 | A | $1.80 |
| J9176 | A | $6.28 |
| J9179 | A | $109.61 |
| J9200 | A | $73.88 |
| J9202 | A | $326.01 |
| J9205 | A | $40.29 |
| J9207 | A | $74.09 |
| J9208 | A | $27.26 |
| J9211 | A | $39.28 |
| J9213 | A | $32.23 |
| J9214 | A | $28.44 |
| J9216 | A | $6,308.13 |
| J9217 | A | $202.12 |
| J9218 | A | $25.73 |
| J9219 | A | $168.48 |
| J9225 | A | $3,203.11 |
| J9226 | A | $27,749.07 |
| J9228 | A | $144.67 |
| J9230 | A | $292.89 |
| J9245 | A | $1,468.85 |
| J9261 | A | $152.01 |
| J9262 | A | $2.85 |
| J9263 | A | $0.18 |
| J9264 | A | $10.75 |
| J9266 | A | $13,915.10 |
| J9268 | A | $2,057.09 |
| J9271 | A | $47.18 |
| J9280 | A | $121.45 |
| J9293 | A | $37.87 |
| J9295 | A | $5.33 |
| J9299 | A | $26.42 |
| J9301 | A | $58.78 |
| J9302 | A | $54.84 |
| J9303 | A | $109.40 |
| J9305 | A | $64.74 |
| J9306 | A | $11.11 |
| J9307 | A | $247.60 |
| J9308 | A | $56.56 |
| J9310 | A | $842.40 |
| J9315 | A | $319.45 |
| J9320 | A | $319.04 |
| J9325 | A | $47.06 |
| J9328 | A | $8.80 |
| J9330 | A | $69.98 |
| J9340 | A | $851.00 |
| J9351 | A | $1.08 |
| J9352 | A | $286.43 |
| J9354 | A | $29.79 |
| J9355 | A | $96.63 |
| J9357 | A | $1,161.95 |
| J9371 | A | $2,600.36 |
| J9395 | A | $96.18 |
| J9400 | A | $8.05 |
| 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 | $39,556.88 |
| Q2049 | A | $508.43 |
| Q2050 | A | $383.83 |
| Q3027 | A | $50.26 |
| Q4172 | A | $120.18 |
| Q5101 | A | $0.73 |
| Q5102 | A | $80.19 |
| Q9950 | A | $21.09 |
| Q9968 | A | $4.29 |
| Q9982 | A | $3,498.00 |
| Q9983 | A | $2,968.00 |
| Q9986 | A | $27.20 |
| Q9989 | A | $12.88 |
| 90371 | A | $108.24 |
| 90375 | A | $287.29 |
| 90376 | A | $313.97 |
| 90378 | A | $176.35 |
| 90396 | A | $1,306.75 |
| 90675 | A | $283.02 |
| 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.

