October 2018 4th QTR ASC Drug File
Effective 10.01.2018 – Revised 04.01.2019
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9515 | A | $5,700.00 |
| A9586 | A | $3,023.16 |
| A9587 | A | $66.74 |
| A9588 | A | $389.55 |
| C9014 | A | $95.40 |
| C9015 | A | $9.67 |
| C9016 | A | $2,826.67 |
| C9024 | A | $186.70 |
| C9028 | A | $2,202.44 |
| C9029 | A | $101.87 |
| C9030 | A | $77.90 |
| C9032 | A | $2,963.29 |
| C9033 | A | $540.60 |
| C9034 | A | $1.11 |
| C9132 | A | $1.93 |
| C9250 | A | $175.12 |
| C9257 | A | $1.98 |
| C9293 | A | $313.31 |
| C9399 | C | $0.00 |
| C9447 | A | $473.24 |
| C9460 | A | $15.46 |
| C9462 | A | $0.46 |
| C9463 | A | $2.10 |
| C9464 | A | $0.94 |
| C9465 | A | $1,033.50 |
| C9466 | A | $167.47 |
| C9467 | A | $45.72 |
| C9468 | A | $3.88 |
| C9482 | A | $9.99 |
| C9488 | A | $31.10 |
| C9492 | A | $73.97 |
| C9493 | A | $19.18 |
| C9497 | A | $150.80 |
| J0129 | A | $52.93 |
| J0135 | A | $1,291.09 |
| J0178 | A | $967.33 |
| J0180 | A | $175.62 |
| J0202 | A | $1,842.13 |
| J0207 | A | $973.41 |
| J0220 | A | $159.63 |
| J0221 | A | $163.83 |
| J0256 | A | $4.46 |
| J0257 | A | $4.65 |
| J0287 | A | $17.72 |
| J0289 | A | $48.07 |
| J0300 | A | $46.33 |
| J0400 | A | $0.76 |
| J0401 | A | $5.24 |
| J0470 | A | $54.42 |
| J0475 | A | $176.02 |
| J0476 | A | $54.66 |
| J0480 | A | $3,686.13 |
| J0485 | A | $3.81 |
| J0490 | A | $44.16 |
| J0561 | A | $13.90 |
| J0565 | A | $40.16 |
| J0570 | A | $1,260.23 |
| J0585 | A | $6.14 |
| J0586 | A | $8.42 |
| J0587 | A | $12.03 |
| J0588 | A | $5.08 |
| J0594 | A | $10.37 |
| J0596 | A | $27.65 |
| J0597 | A | $48.94 |
| J0598 | A | $54.26 |
| J0600 | A | $5,594.42 |
| J0606 | A | $2.98 |
| J0630 | A | $2,629.53 |
| J0637 | A | $12.64 |
| J0638 | A | $111.00 |
| J0641 | A | $0.24 |
| J0695 | A | $5.46 |
| J0712 | A | $2.89 |
| J0714 | A | $84.25 |
| J0716 | A | $4,592.80 |
| J0717 | A | $8.11 |
| J0740 | A | $478.07 |
| J0775 | A | $45.05 |
| J0795 | A | $8.59 |
| J0800 | A | $3,984.76 |
| J0840 | A | $3,250.52 |
| J0850 | A | $1,129.15 |
| J0875 | A | $14.35 |
| J0878 | A | $0.32 |
| J0881 | A | $3.77 |
| J0882 | A | $3.77 |
| J0883 | A | $1.23 |
| J0884 | A | $1.23 |
| J0885 | A | $12.27 |
| J0888 | A | $1.74 |
| J0894 | A | $14.07 |
| J0897 | A | $18.58 |
| J1110 | A | $73.47 |
| J1130 | A | $0.22 |
| J1162 | A | $3,688.29 |
| J1190 | A | $229.93 |
| J1212 | A | $535.99 |
| J1290 | A | $477.96 |
| J1300 | A | $230.48 |
| J1322 | A | $236.63 |
| J1327 | A | $16.28 |
| J1364 | A | $78.87 |
| J1410 | A | $308.63 |
| J1428 | A | $168.12 |
| J1430 | A | $444.10 |
| J1438 | A | $645.54 |
| J1439 | A | $1.06 |
| J1442 | A | $1.02 |
| J1447 | A | $0.58 |
| J1451 | A | $7.41 |
| J1453 | A | $2.19 |
| J1455 | A | $82.27 |
| J1458 | A | $389.95 |
| J1459 | A | $39.63 |
| J1460 | A | $38.05 |
| J1555 | A | $13.40 |
| J1556 | A | $70.52 |
| J1557 | A | $52.06 |
| J1559 | A | $9.86 |
| J1560 | A | $380.48 |
| J1561 | A | $39.49 |
| J1566 | A | $37.95 |
| J1568 | A | $36.72 |
| J1569 | A | $43.14 |
| J1571 | A | $64.22 |
| J1572 | A | $35.07 |
| J1573 | A | $64.22 |
| J1575 | A | $14.13 |
| J1595 | A | $201.17 |
| J1602 | A | $24.01 |
| J1610 | A | $214.39 |
| J1627 | A | $3.58 |
| J1640 | A | $23.03 |
| J1670 | A | $255.70 |
| J1726 | A | $27.93 |
| J1740 | A | $56.24 |
| J1742 | A | $240.76 |
| J1743 | A | $536.56 |
| J1744 | A | $359.00 |
| J1745 | A | $78.83 |
| J1750 | A | $14.06 |
| J1786 | A | $41.45 |
| J1826 | A | $604.40 |
| J1830 | A | $379.63 |
| J1833 | A | $0.85 |
| J1930 | A | $58.84 |
| J1931 | A | $30.78 |
| J1942 | A | $2.44 |
| J1950 | A | $1,193.67 |
| J2182 | A | $29.58 |
| J2265 | A | $1.57 |
| J2278 | A | $7.59 |
| J2315 | A | $3.26 |
| J2320 | A | $72.58 |
| J2323 | A | $19.83 |
| J2325 | A | $73.34 |
| J2326 | A | $1,101.87 |
| J2350 | A | $57.34 |
| J2353 | A | $198.51 |
| J2355 | A | $426.92 |
| J2357 | A | $37.07 |
| J2407 | A | $23.08 |
| J2425 | A | $20.29 |
| J2426 | A | $10.94 |
| J2469 | A | $17.14 |
| J2502 | A | $289.62 |
| J2503 | A | $713.86 |
| J2504 | A | $367.96 |
| J2505 | A | $4,687.71 |
| J2507 | A | $2,334.59 |
| J2515 | A | $47.08 |
| J2547 | A | $1.62 |
| J2562 | A | $330.41 |
| J2597 | A | $12.60 |
| J2724 | A | $15.15 |
| J2760 | A | $392.84 |
| J2770 | A | $418.37 |
| J2778 | A | $373.36 |
| J2783 | A | $278.15 |
| J2786 | A | $9.30 |
| J2792 | A | $27.02 |
| J2793 | A | $24.09 |
| J2794 | A | $9.41 |
| J2796 | A | $71.40 |
| J2820 | A | $37.61 |
| J2840 | A | $541.13 |
| J2850 | A | $34.78 |
| J2860 | A | $95.35 |
| J2941 | A | $74.65 |
| J2993 | A | $2,301.91 |
| J2997 | A | $87.78 |
| J3060 | A | $40.39 |
| J3070 | A | $108.39 |
| J3090 | A | $1.43 |
| J3095 | A | $5.47 |
| J3101 | A | $121.76 |
| J3145 | A | $1.36 |
| J3240 | A | $1,624.45 |
| J3243 | A | $2.06 |
| J3246 | A | $8.26 |
| J3262 | A | $4.73 |
| J3285 | A | $66.14 |
| J3300 | A | $3.86 |
| J3315 | A | $267.38 |
| J3357 | A | $191.03 |
| J3358 | A | $12.28 |
| J3380 | A | $19.58 |
| J3385 | A | $345.39 |
| J3396 | A | $10.95 |
| J3465 | A | $1.90 |
| J7175 | A | $7.17 |
| J7178 | A | $1.16 |
| J7179 | A | $2.02 |
| J7180 | A | $8.23 |
| J7181 | A | $14.91 |
| J7182 | A | $1.34 |
| J7183 | A | $1.01 |
| J7185 | A | $1.22 |
| J7186 | A | $0.99 |
| J7187 | A | $1.12 |
| J7188 | A | $2.85 |
| J7189 | A | $2.06 |
| J7190 | A | $1.07 |
| J7192 | A | $1.33 |
| J7193 | A | $1.12 |
| J7194 | A | $1.42 |
| J7195 | A | $1.51 |
| J7197 | A | $3.49 |
| J7198 | A | $2.08 |
| J7200 | A | $1.30 |
| J7201 | A | $2.99 |
| J7202 | A | $4.28 |
| J7205 | A | $2.01 |
| J7207 | A | $1.72 |
| J7209 | A | $1.42 |
| J7210 | A | $1.36 |
| J7211 | A | $1.26 |
| J7308 | A | $404.59 |
| J7311 | A | $20,130.50 |
| J7312 | A | $200.17 |
| J7313 | A | $490.33 |
| J7316 | A | $1,040.50 |
| J7320 | A | $10.60 |
| J7321 | A | $85.30 |
| J7322 | A | $19.26 |
| J7323 | A | $141.47 |
| J7324 | A | $147.79 |
| J7325 | A | $11.83 |
| J7326 | A | $537.36 |
| J7327 | A | $779.35 |
| J7328 | A | $2.18 |
| J7336 | A | $3.16 |
| J7340 | A | $2.14 |
| J7342 | A | $29.98 |
| J7345 | A | $1.38 |
| J7501 | A | $229.36 |
| J7503 | A | $1.26 |
| J7504 | A | $2,081.22 |
| J7505 | A | $6.80 |
| J7511 | A | $751.25 |
| J7525 | A | $205.62 |
| J8501 | A | $6.72 |
| J8560 | A | $75.56 |
| J8655 | A | $301.94 |
| J8670 | A | $2.21 |
| J8705 | A | $103.65 |
| J9015 | A | $4,138.14 |
| J9017 | A | $77.03 |
| J9019 | A | $414.83 |
| J9022 | A | $76.91 |
| J9023 | A | $81.82 |
| J9025 | A | $1.47 |
| J9027 | A | $111.29 |
| J9031 | A | $140.62 |
| J9032 | A | $37.74 |
| J9033 | A | $30.58 |
| J9034 | A | $23.84 |
| J9035 | A | $79.25 |
| J9039 | A | $110.37 |
| J9041 | A | $45.55 |
| J9042 | A | $150.48 |
| J9043 | A | $167.99 |
| J9047 | A | $36.32 |
| J9050 | A | $4,051.50 |
| J9055 | A | $60.63 |
| J9065 | A | $22.64 |
| J9070 | A | $41.61 |
| J9098 | A | $628.37 |
| J9120 | A | $1,427.67 |
| J9145 | A | $52.41 |
| J9150 | A | $50.66 |
| J9155 | A | $3.72 |
| J9171 | A | $1.51 |
| J9176 | A | $6.42 |
| J9179 | A | $114.34 |
| J9185 | A | $59.94 |
| J9202 | A | $509.02 |
| J9203 | A | $193.16 |
| J9205 | A | $45.53 |
| J9207 | A | $70.99 |
| J9211 | A | $34.26 |
| J9214 | A | $34.15 |
| J9217 | A | $228.41 |
| J9218 | A | $27.17 |
| J9225 | A | $3,610.32 |
| J9226 | A | $31,835.05 |
| J9228 | A | $150.87 |
| J9230 | A | $321.72 |
| J9245 | A | $814.80 |
| J9261 | A | $152.21 |
| J9262 | A | $2.98 |
| J9264 | A | $11.60 |
| J9266 | A | $15,028.71 |
| J9268 | A | $2,096.29 |
| J9271 | A | $49.35 |
| J9280 | A | $134.25 |
| J9285 | A | $51.04 |
| J9293 | A | $27.36 |
| J9295 | A | $5.57 |
| J9299 | A | $27.54 |
| J9301 | A | $62.63 |
| J9302 | A | $58.55 |
| J9303 | A | $114.38 |
| J9305 | A | $68.22 |
| J9306 | A | $11.87 |
| J9307 | A | $271.61 |
| J9308 | A | $57.68 |
| J9310 | A | $919.85 |
| J9315 | A | $322.58 |
| J9320 | A | $348.71 |
| J9325 | A | $49.99 |
| J9328 | A | $10.55 |
| J9330 | A | $73.75 |
| J9340 | A | $741.58 |
| J9352 | A | $300.67 |
| J9354 | A | $30.78 |
| J9355 | A | $104.12 |
| J9357 | A | $1,328.67 |
| J9371 | A | $2,916.62 |
| J9395 | A | $97.94 |
| J9400 | A | $8.32 |
| J9600 | A | $21,219.57 |
| P9041 | A | $10.49 |
| P9045 | A | $52.45 |
| P9046 | A | $20.98 |
| P9047 | A | $52.45 |
| Q0138 | A | $0.98 |
| Q0139 | A | $0.98 |
| Q2009 | A | $4.40 |
| Q2017 | A | $2,575.15 |
| Q2043 | A | $43,419.43 |
| Q2050 | A | $383.57 |
| Q3027 | A | $54.11 |
| Q4172 | A | $120.78 |
| Q5101 | A | $0.64 |
| Q5103 | A | $61.36 |
| Q5104 | A | $64.38 |
| Q5105 | A | $1.17 |
| Q5106 | A | $11.69 |
| Q5108 | A | $368.79 |
| Q5110 | A | $0.77 |
| Q9950 | A | $21.25 |
| Q9968 | A | $3.86 |
| Q9982 | A | $3,498.00 |
| Q9983 | A | $2,968.00 |
| Q9991 | A | $1,674.80 |
| Q9992 | A | $1,674.80 |
| Q9993 | A | $18.88 |
| Q9995 | A | $48.86 |
| 90371 | A | $112.33 |
| 90375 | A | $334.99 |
| 90376 | A | $324.95 |
| 90378 | A | $1,514.17 |
| 90396 | A | $1,491.37 |
| 90675 | A | $291.44 |
| 90676 | A | $196.54 |
| 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 2018 by the American Medical Association.

