October 2017 4th Quarter ASC Drug File
Effective: 10.01.2017
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 | $1.86 |
| C9140 | A | $1.41 |
| C9248 | A | $2.43 |
| C9250 | A | $111.35 |
| C9257 | A | $1.88 |
| C9293 | A | $298.60 |
| C9399 | C | $0.00 |
| C9447 | A | $473.24 |
| C9460 | A | $15.17 |
| C9482 | A | $9.99 |
| C9483 | A | $75.64 |
| C9484 | A | $169.60 |
| C9485 | A | $49.95 |
| C9486 | A | $4.88 |
| C9488 | A | $30.52 |
| C9489 | A | $1,103.79 |
| C9490 | A | $40.23 |
| C9491 | A | $79.44 |
| C9492 | A | $73.75 |
| C9493 | A | $19.19 |
| C9494 | A | $57.42 |
| C9497 | A | $153.70 |
| J0120 | A | $7.29 |
| J0129 | A | $49.59 |
| J0130 | A | $1,215.20 |
| J0135 | A | $1,176.93 |
| J0178 | A | $974.59 |
| J0180 | A | $171.07 |
| J0202 | A | $1,778.60 |
| J0207 | A | $959.81 |
| J0215 | A | $41.64 |
| J0220 | A | $206.70 |
| J0221 | A | $159.73 |
| J0256 | A | $4.94 |
| J0257 | A | $4.57 |
| J0287 | A | $13.86 |
| J0289 | A | $21.52 |
| J0300 | A | $194.26 |
| J0401 | A | $4.89 |
| J0475 | A | $164.62 |
| J0476 | A | $70.34 |
| J0480 | A | $3,440.37 |
| J0485 | A | $3.94 |
| J0490 | A | $42.81 |
| J0561 | A | $11.92 |
| J0570 | A | $1,261.31 |
| J0583 | A | $1.23 |
| J0585 | A | $6.03 |
| J0586 | A | $8.26 |
| J0587 | A | $11.98 |
| J0588 | A | $5.08 |
| J0594 | A | $34.73 |
| J0596 | A | $27.99 |
| J0597 | A | $48.97 |
| J0598 | A | $57.21 |
| J0600 | A | $5,594.42 |
| J0630 | A | $2,287.94 |
| J0637 | A | $12.46 |
| J0638 | A | $106.12 |
| J0641 | A | $0.53 |
| J0695 | A | $4.96 |
| J0712 | A | $2.63 |
| J0714 | A | $76.92 |
| J0716 | A | $4,459.02 |
| J0717 | A | $7.47 |
| J0740 | A | $477.55 |
| J0775 | A | $41.83 |
| J0795 | A | $8.61 |
| J0800 | A | $3,771.36 |
| J0840 | A | $2,870.72 |
| J0850 | A | $1,128.71 |
| J0875 | A | $14.40 |
| J0878 | A | $0.62 |
| J0881 | A | $3.95 |
| J0882 | A | $3.95 |
| J0883 | A | $1.29 |
| J0885 | A | $12.94 |
| J0894 | A | $17.70 |
| J0897 | A | $17.33 |
| J1130 | A | $0.19 |
| J1162 | A | $3,267.03 |
| J1190 | A | $185.89 |
| J1205 | A | $60.94 |
| J1212 | A | $554.16 |
| J1290 | A | $441.29 |
| J1300 | A | $226.63 |
| J1322 | A | $230.96 |
| J1324 | A | $18.63 |
| J1327 | A | $21.74 |
| J1364 | A | $64.90 |
| J1410 | A | $304.61 |
| J1430 | A | $443.68 |
| J1438 | A | $588.57 |
| J1439 | A | $1.06 |
| J1442 | A | $1.01 |
| J1447 | A | $0.63 |
| J1451 | A | $7.21 |
| J1453 | A | $2.03 |
| J1455 | A | $75.17 |
| J1458 | A | $380.50 |
| J1459 | A | $38.51 |
| J1460 | A | $31.76 |
| J1556 | A | $38.31 |
| J1557 | A | $41.08 |
| J1559 | A | $9.81 |
| J1560 | A | $317.64 |
| J1561 | A | $38.94 |
| J1566 | A | $34.28 |
| J1568 | A | $36.62 |
| J1569 | A | $39.78 |
| J1571 | A | $61.12 |
| J1572 | A | $29.84 |
| J1573 | A | $61.12 |
| J1575 | A | $13.14 |
| J1595 | A | $214.44 |
| J1602 | A | $24.74 |
| J1610 | A | $205.55 |
| J1640 | A | $24.00 |
| J1670 | A | $557.45 |
| J1730 | A | $690.03 |
| J1740 | A | $82.87 |
| J1742 | A | $169.14 |
| J1743 | A | $542.86 |
| J1744 | A | $335.34 |
| J1745 | A | $87.15 |
| J1750 | A | $13.04 |
| J1786 | A | $41.69 |
| J1826 | A | $482.21 |
| J1830 | A | $380.40 |
| J1833 | A | $0.69 |
| J1930 | A | $55.98 |
| J1931 | A | $30.61 |
| J1942 | A | $2.46 |
| J1945 | A | $12.71 |
| J1950 | A | $1,087.91 |
| J2182 | A | $27.77 |
| J2260 | A | $1.94 |
| J2265 | A | $1.55 |
| J2278 | A | $7.42 |
| J2315 | A | $3.26 |
| J2320 | A | $133.36 |
| J2323 | A | $19.42 |
| J2325 | A | $73.30 |
| J2353 | A | $183.64 |
| J2355 | A | $467.22 |
| J2357 | A | $34.93 |
| J2358 | A | $2.92 |
| J2407 | A | $23.36 |
| J2425 | A | $19.20 |
| J2426 | A | $10.02 |
| J2469 | A | $20.90 |
| J2502 | A | $267.20 |
| J2503 | A | $729.47 |
| J2504 | A | $352.27 |
| J2505 | A | $4,320.73 |
| J2507 | A | $2,006.66 |
| J2510 | A | $29.30 |
| J2515 | A | $52.40 |
| J2547 | A | $1.61 |
| J2562 | A | $314.44 |
| J2597 | A | $12.75 |
| J2670 | A | $1,600.40 |
| J2724 | A | $15.13 |
| J2730 | A | $87.58 |
| J2760 | A | $358.28 |
| J2770 | A | $428.62 |
| J2778 | A | $378.35 |
| J2783 | A | $263.06 |
| J2786 | A | $8.85 |
| J2792 | A | $23.80 |
| J2793 | A | $24.09 |
| J2794 | A | $8.63 |
| J2796 | A | $66.86 |
| J2820 | A | $37.70 |
| J2840 | A | $530.00 |
| J2850 | A | $34.78 |
| J2860 | A | $92.78 |
| J2941 | A | $81.59 |
| J2993 | A | $2,301.91 |
| J2997 | A | $83.99 |
| J3060 | A | $40.37 |
| J3070 | A | $71.47 |
| J3090 | A | $1.33 |
| J3095 | A | $5.12 |
| J3101 | A | $111.70 |
| J3240 | A | $1,579.69 |
| J3243 | A | $2.99 |
| J3246 | A | $9.19 |
| J3262 | A | $4.37 |
| J3285 | A | $61.24 |
| J3300 | A | $3.88 |
| J3315 | A | $391.11 |
| J3355 | A | $132.66 |
| J3357 | A | $187.26 |
| J3365 | A | $262.79 |
| J3380 | A | $18.59 |
| J3385 | A | $342.35 |
| J3396 | A | $10.76 |
| J3465 | A | $2.70 |
| J7175 | A | $6.83 |
| J7178 | A | $1.16 |
| J7179 | A | $2.27 |
| J7180 | A | $8.21 |
| J7181 | A | $15.13 |
| J7182 | A | $1.29 |
| J7183 | A | $1.04 |
| J7185 | A | $1.25 |
| J7186 | A | $0.98 |
| J7187 | A | $1.09 |
| J7188 | A | $5.30 |
| J7189 | A | $2.00 |
| J7190 | A | $1.02 |
| J7191 | A | $0.20 |
| J7192 | A | $1.24 |
| J7193 | A | $1.14 |
| J7194 | A | $1.39 |
| J7195 | A | $1.50 |
| J7196 | A | $103.35 |
| J7197 | A | $3.75 |
| J7198 | A | $1.94 |
| J7200 | A | $1.27 |
| J7201 | A | $2.99 |
| J7202 | A | $4.14 |
| J7205 | A | $2.02 |
| J7207 | A | $1.87 |
| J7209 | A | $1.52 |
| J7308 | A | $367.81 |
| J7309 | A | $83.69 |
| J7310 | A | $11.71 |
| J7311 | A | $20,114.35 |
| J7312 | A | $200.74 |
| J7313 | A | $490.80 |
| J7316 | A | $1,046.75 |
| J7321 | A | $87.64 |
| J7322 | A | $19.26 |
| J7323 | A | $155.23 |
| J7324 | A | $149.48 |
| J7325 | A | $12.27 |
| J7326 | A | $510.57 |
| J7327 | A | $856.79 |
| J7328 | A | $2.18 |
| J7340 | A | $2.14 |
| J7342 | A | $29.96 |
| J7501 | A | $238.08 |
| J7503 | A | $1.24 |
| J7504 | A | $1,817.04 |
| J7505 | A | $231.22 |
| J7511 | A | $710.35 |
| J7513 | A | $10.00 |
| J7525 | A | $188.32 |
| J8501 | A | $7.66 |
| J8510 | A | $24.83 |
| J8560 | A | $74.18 |
| J8650 | A | $38.20 |
| J8655 | A | $458.47 |
| J8670 | A | $2.30 |
| J8700 | A | $1.46 |
| J8705 | A | $103.63 |
| J9015 | A | $3,598.38 |
| J9017 | A | $71.34 |
| J9019 | A | $402.74 |
| J9025 | A | $1.66 |
| J9027 | A | $149.96 |
| J9031 | A | $131.25 |
| J9032 | A | $35.21 |
| J9033 | A | $29.19 |
| J9034 | A | $23.77 |
| J9035 | A | $75.18 |
| J9039 | A | $103.43 |
| J9041 | A | $46.87 |
| J9042 | A | $139.39 |
| J9043 | A | $159.10 |
| J9047 | A | $33.16 |
| J9050 | A | $3,863.47 |
| J9055 | A | $57.62 |
| J9065 | A | $20.66 |
| J9070 | A | $42.06 |
| J9098 | A | $641.67 |
| J9120 | A | $1,404.01 |
| J9145 | A | $49.15 |
| J9150 | A | $37.86 |
| J9151 | A | $243.80 |
| J9155 | A | $3.64 |
| J9171 | A | $1.89 |
| J9176 | A | $6.26 |
| J9179 | A | $109.16 |
| J9200 | A | $72.67 |
| J9202 | A | $351.53 |
| J9205 | A | $41.13 |
| J9207 | A | $74.10 |
| J9208 | A | $26.85 |
| J9211 | A | $39.47 |
| J9213 | A | $32.23 |
| J9214 | A | $31.71 |
| J9216 | A | $6,308.13 |
| J9217 | A | $209.71 |
| J9218 | A | $25.97 |
| J9219 | A | $168.48 |
| J9225 | A | $3,284.12 |
| J9226 | A | $29,003.67 |
| J9228 | A | $146.78 |
| J9230 | A | $292.48 |
| J9245 | A | $1,369.46 |
| J9261 | A | $151.66 |
| J9262 | A | $2.85 |
| J9263 | A | $0.19 |
| J9264 | A | $10.78 |
| J9266 | A | $13,907.58 |
| J9268 | A | $2,001.26 |
| J9271 | A | $47.97 |
| J9280 | A | $133.65 |
| J9293 | A | $38.98 |
| J9295 | A | $5.29 |
| J9299 | A | $26.80 |
| J9301 | A | $58.94 |
| J9302 | A | $54.91 |
| J9303 | A | $110.28 |
| J9305 | A | $64.98 |
| J9306 | A | $11.16 |
| J9307 | A | $247.97 |
| J9308 | A | $56.53 |
| J9310 | A | $848.41 |
| J9315 | A | $328.83 |
| J9320 | A | $322.73 |
| J9325 | A | $47.21 |
| J9328 | A | $9.70 |
| J9330 | A | $70.51 |
| J9340 | A | $828.90 |
| J9351 | A | $1.25 |
| J9352 | A | $289.17 |
| J9354 | A | $29.81 |
| J9355 | A | $97.80 |
| J9357 | A | $1,198.56 |
| J9371 | A | $2,701.78 |
| J9395 | A | $96.77 |
| J9400 | A | $8.15 |
| J9600 | A | $21,219.57 |
| P9041 | A | $11.80 |
| P9045 | A | $54.72 |
| P9046 | A | $22.49 |
| P9047 | A | $53.44 |
| Q0138 | A | $0.91 |
| Q0139 | A | $0.91 |
| Q2017 | A | $2,645.71 |
| Q2043 | A | $40,440.17 |
| Q2049 | A | $508.43 |
| Q2050 | A | $374.93 |
| Q3027 | A | $50.11 |
| Q4172 | A | $120.78 |
| Q5101 | A | $0.71 |
| Q5102 | A | $78.72 |
| Q9950 | A | $21.25 |
| Q9968 | A | $4.04 |
| Q9982 | A | $3,498.00 |
| Q9983 | A | $2,968.00 |
| Q9986 | A | $27.07 |
| Q9989 | A | $12.88 |
| 90371 | A | $124.27 |
| 90375 | A | $314.27 |
| 90376 | A | $317.43 |
| 90378 | A | $176.35 |
| 90396 | A | $1,304.84 |
| 90675 | A | $269.12 |
| 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.

