July 2019 3rd Quarter ASC Drug File
Effective 07.01.2019 – Revised 07.01.2020
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9586 | A | $3,028.84 |
| A9587 | A | $68.70 |
| A9588 | A | $424.53 |
| C9035 | A | $2.80 |
| C9036 | A | $98.44 |
| C9037 | A | $9.87 |
| C9038 | A | $200.87 |
| C9039 | A | $3.17 |
| C9040 | A | $2.61 |
| C9041 | A | $291.50 |
| C9042 | A | $23.49 |
| C9043 | A | $4.10 |
| C9044 | A | $27.45 |
| C9045 | A | $22.08 |
| C9046 | A | $0.94 |
| C9047 | A | $683.55 |
| C9048 | A | $138.75 |
| C9049 | A | $251.63 |
| C9050 | A | $784.52 |
| C9051 | A | $3.55 |
| C9052 | A | $219.87 |
| C9132 | A | $2.01 |
| C9248 | A | $2.77 |
| C9250 | A | $164.84 |
| C9257 | A | $2.03 |
| C9290 | A | $1.22 |
| C9293 | A | $313.20 |
| C9399 | C | $0.00 |
| C9407 | A | $320.12 |
| C9447 | A | $458.56 |
| C9460 | A | $15.41 |
| C9462 | A | $0.47 |
| C9482 | A | $9.99 |
| C9488 | A | $32.95 |
| J0129 | A | $53.94 |
| J0135 | A | $1,371.14 |
| J0178 | A | $957.36 |
| J0180 | A | $182.43 |
| J0185 | A | $2.27 |
| J0202 | A | $1,918.35 |
| J0207 | A | $977.31 |
| J0220 | A | $141.14 |
| J0221 | A | $170.08 |
| J0256 | A | $4.51 |
| J0257 | A | $4.89 |
| J0287 | A | $7.12 |
| J0289 | A | $18.33 |
| J0300 | A | $56.62 |
| J0401 | A | $5.45 |
| J0475 | A | $173.39 |
| J0480 | A | $3,789.63 |
| J0485 | A | $3.78 |
| J0490 | A | $44.82 |
| J0517 | A | $168.84 |
| J0558 | A | $11.02 |
| J0561 | A | $13.85 |
| J0565 | A | $39.90 |
| J0567 | A | $93.50 |
| J0570 | A | $1,261.87 |
| J0584 | A | $353.06 |
| J0585 | A | $6.12 |
| J0586 | A | $8.42 |
| J0587 | A | $12.02 |
| J0588 | A | $5.05 |
| J0594 | A | $5.78 |
| J0596 | A | $27.82 |
| J0597 | A | $51.35 |
| J0598 | A | $57.16 |
| J0599 | A | $9.67 |
| J0600 | A | $5,594.42 |
| J0606 | A | $2.68 |
| J0630 | A | $2,647.26 |
| J0637 | A | $9.81 |
| J0638 | A | $111.01 |
| J0641 | A | $0.16 |
| J0695 | A | $5.59 |
| J0712 | A | $3.16 |
| J0714 | A | $91.13 |
| J0716 | A | $4,822.43 |
| J0717 | A | $8.13 |
| J0725 | A | $22.37 |
| J0740 | A | $643.29 |
| J0775 | A | $47.09 |
| J0795 | A | $9.05 |
| J0840 | A | $3,237.01 |
| J0841 | A | $1,265.80 |
| J0850 | A | $1,129.15 |
| J0875 | A | $14.62 |
| J0878 | A | $0.35 |
| J0881 | A | $3.83 |
| J0882 | A | $3.83 |
| J0883 | A | $1.32 |
| J0884 | A | $1.32 |
| J0885 | A | $11.46 |
| J0894 | A | $7.46 |
| J0897 | A | $19.10 |
| J1095 | A | $1.22 |
| J1162 | A | $3,780.26 |
| J1190 | A | $194.72 |
| J1212 | A | $558.87 |
| J1290 | A | $480.55 |
| J1300 | A | $230.48 |
| J1301 | A | $19.50 |
| J1322 | A | $236.76 |
| J1327 | A | $5.09 |
| J1364 | A | $78.87 |
| J1410 | A | $309.33 |
| J1428 | A | $167.77 |
| J1430 | A | $444.10 |
| J1438 | A | $685.56 |
| J1439 | A | $1.09 |
| J1442 | A | $0.98 |
| J1447 | A | $0.58 |
| J1451 | A | $7.63 |
| J1453 | A | $2.00 |
| J1454 | A | $460.42 |
| J1455 | A | $82.27 |
| J1458 | A | $390.07 |
| J1459 | A | $40.60 |
| J1460 | A | $40.54 |
| J1555 | A | $13.86 |
| J1556 | A | $70.52 |
| J1557 | A | $45.55 |
| J1559 | A | $10.19 |
| J1560 | A | $405.36 |
| J1561 | A | $38.45 |
| J1566 | A | $64.39 |
| J1568 | A | $38.68 |
| J1569 | A | $40.83 |
| J1571 | A | $60.35 |
| J1572 | A | $35.77 |
| J1573 | A | $60.35 |
| J1575 | A | $14.02 |
| J1595 | A | $175.77 |
| J1602 | A | $22.07 |
| J1610 | A | $200.26 |
| J1627 | A | $3.05 |
| J1628 | A | $99.30 |
| J1640 | A | $23.76 |
| J1670 | A | $418.84 |
| J1726 | A | $23.46 |
| J1740 | A | $45.73 |
| J1742 | A | $152.86 |
| J1743 | A | $542.89 |
| J1744 | A | $368.20 |
| J1745 | A | $64.87 |
| J1746 | A | $58.71 |
| J1750 | A | $14.41 |
| J1786 | A | $42.87 |
| J1826 | A | $2,785.97 |
| J1830 | A | $382.50 |
| J1833 | A | $0.78 |
| J1930 | A | $63.21 |
| J1931 | A | $31.95 |
| J1942 | A | $2.66 |
| J1950 | A | $1,267.77 |
| J2062 | A | $15.32 |
| J2182 | A | $30.04 |
| J2186 | A | $1.67 |
| J2265 | A | $1.74 |
| J2278 | A | $7.91 |
| J2315 | A | $3.23 |
| J2320 | A | $21.69 |
| J2323 | A | $20.29 |
| J2325 | A | $74.80 |
| J2326 | A | $1,101.54 |
| J2350 | A | $57.42 |
| J2353 | A | $204.69 |
| J2355 | A | $163.98 |
| J2357 | A | $37.05 |
| J2407 | A | $24.14 |
| J2425 | A | $21.30 |
| J2426 | A | $11.48 |
| J2469 | A | $8.93 |
| J2502 | A | $314.34 |
| J2504 | A | $367.96 |
| J2505 | A | $4,526.81 |
| J2507 | A | $2,485.24 |
| J2515 | A | $38.04 |
| J2547 | A | $1.64 |
| J2562 | A | $347.24 |
| J2597 | A | $11.97 |
| J2724 | A | $15.06 |
| J2760 | A | $392.15 |
| J2770 | A | $418.10 |
| J2778 | A | $357.34 |
| J2783 | A | $287.64 |
| J2786 | A | $9.47 |
| J2792 | A | $30.10 |
| J2794 | A | $9.95 |
| J2796 | A | $73.51 |
| J2797 | A | $0.94 |
| J2820 | A | $42.40 |
| J2840 | A | $541.13 |
| J2850 | A | $34.78 |
| J2860 | A | $100.77 |
| J2993 | A | $2,581.84 |
| J2997 | A | $87.69 |
| J3060 | A | $40.34 |
| J3090 | A | $1.48 |
| J3095 | A | $5.85 |
| J3101 | A | $121.79 |
| J3145 | A | $1.41 |
| J3240 | A | $1,690.30 |
| J3243 | A | $1.69 |
| J3245 | A | $126.88 |
| J3246 | A | $10.98 |
| J3262 | A | $4.93 |
| J3285 | A | $64.92 |
| J3300 | A | $3.85 |
| J3304 | A | $18.88 |
| J3315 | A | $248.39 |
| J3316 | A | $2,897.08 |
| J3357 | A | $190.71 |
| J3358 | A | $12.00 |
| J3380 | A | $20.13 |
| J3385 | A | $345.14 |
| J3396 | A | $11.05 |
| J3397 | A | $218.74 |
| J3398 | A | $2,913.23 |
| J7170 | A | $47.37 |
| J7175 | A | $7.51 |
| J7177 | A | $1.39 |
| J7178 | A | $1.20 |
| J7179 | A | $1.88 |
| J7180 | A | $8.47 |
| J7181 | A | $15.15 |
| J7182 | A | $1.30 |
| J7183 | A | $1.01 |
| J7185 | A | $1.25 |
| J7186 | A | $1.05 |
| J7187 | A | $1.16 |
| J7188 | A | $3.17 |
| J7189 | A | $2.13 |
| J7190 | A | $1.14 |
| J7192 | A | $1.26 |
| J7193 | A | $1.12 |
| J7194 | A | $1.44 |
| J7195 | A | $1.51 |
| J7196 | A | $103.35 |
| J7197 | A | $3.41 |
| J7198 | A | $1.93 |
| J7200 | A | $1.40 |
| J7201 | A | $3.12 |
| J7202 | A | $4.31 |
| J7203 | A | $3.89 |
| J7205 | A | $2.10 |
| J7207 | A | $1.74 |
| J7208 | A | $2.02 |
| J7209 | A | $1.39 |
| J7210 | A | $1.36 |
| J7211 | A | $1.26 |
| J7308 | A | $401.39 |
| J7311 | A | $20,125.83 |
| J7312 | A | $199.81 |
| J7313 | A | $490.94 |
| J7316 | A | $1,046.93 |
| J7318 | A | $17.23 |
| J7320 | A | $16.92 |
| J7321 | A | $74.85 |
| J7322 | A | $20.80 |
| J7323 | A | $143.29 |
| J7324 | A | $506.68 |
| J7325 | A | $11.39 |
| J7326 | A | $1,166.00 |
| J7327 | A | $1,511.15 |
| J7328 | A | $2.18 |
| J7329 | A | $7.20 |
| J7336 | A | $3.15 |
| J7342 | A | $29.96 |
| J7345 | A | $1.46 |
| J7501 | A | $241.79 |
| J7504 | A | $2,072.24 |
| J7511 | A | $761.12 |
| J7525 | A | $211.78 |
| J8560 | A | $74.61 |
| J8562 | A | $81.42 |
| J8600 | A | $12.00 |
| J8655 | A | $250.20 |
| J8670 | A | $2.22 |
| J9015 | A | $4,138.14 |
| J9017 | A | $51.23 |
| J9019 | A | $414.83 |
| J9022 | A | $77.18 |
| J9023 | A | $82.74 |
| J9025 | A | $1.27 |
| J9027 | A | $57.58 |
| J9030 | A | $2.82 |
| J9032 | A | $39.39 |
| J9033 | A | $28.88 |
| J9034 | A | $23.80 |
| J9035 | A | $81.28 |
| J9036 | A | $23.49 |
| J9039 | A | $112.96 |
| J9041 | A | $44.53 |
| J9042 | A | $163.07 |
| J9043 | A | $173.46 |
| J9044 | A | $25.19 |
| J9047 | A | $37.25 |
| J9050 | A | $3,534.85 |
| J9055 | A | $62.11 |
| J9057 | A | $77.90 |
| J9065 | A | $19.73 |
| J9070 | A | $34.73 |
| J9098 | A | $628.37 |
| J9120 | A | $1,094.18 |
| J9145 | A | $53.75 |
| J9150 | A | $47.14 |
| J9151 | A | $0.32 |
| J9153 | A | $192.31 |
| J9155 | A | $3.90 |
| J9171 | A | $0.85 |
| J9173 | A | $74.86 |
| J9176 | A | $6.49 |
| J9179 | A | $115.76 |
| J9202 | A | $500.25 |
| J9203 | A | $197.69 |
| J9205 | A | $49.79 |
| J9207 | A | $89.45 |
| J9213 | A | $169.33 |
| J9214 | A | $33.99 |
| J9217 | A | $229.52 |
| J9225 | A | $3,897.40 |
| J9226 | A | $34,994.49 |
| J9228 | A | $153.06 |
| J9229 | A | $2,250.50 |
| J9230 | A | $328.29 |
| J9245 | A | $636.13 |
| J9261 | A | $152.32 |
| J9262 | A | $3.11 |
| J9264 | A | $12.30 |
| J9266 | A | $16,430.06 |
| J9268 | A | $2,020.30 |
| J9270 | A | $6.12 |
| J9271 | A | $49.58 |
| J9280 | A | $100.38 |
| J9285 | A | $52.06 |
| J9293 | A | $27.27 |
| J9295 | A | $5.74 |
| J9299 | A | $27.80 |
| J9301 | A | $63.34 |
| J9302 | A | $59.80 |
| J9303 | A | $117.76 |
| J9305 | A | $69.54 |
| J9306 | A | $12.25 |
| J9307 | A | $286.53 |
| J9308 | A | $58.39 |
| J9311 | A | $44.32 |
| J9312 | A | $94.97 |
| J9315 | A | $310.55 |
| J9320 | A | $344.84 |
| J9325 | A | $51.10 |
| J9328 | A | $10.40 |
| J9330 | A | $57.93 |
| J9340 | A | $420.43 |
| J9352 | A | $310.84 |
| J9354 | A | $31.29 |
| J9355 | A | $106.98 |
| J9356 | A | $80.26 |
| J9357 | A | $1,384.14 |
| J9371 | A | $3,030.37 |
| J9395 | A | $98.78 |
| J9400 | A | $8.42 |
| J9600 | A | $21,219.57 |
| P9041 | A | $10.49 |
| P9045 | A | $52.45 |
| P9046 | A | $20.98 |
| P9047 | A | $52.45 |
| Q0138 | A | $1.00 |
| Q0139 | A | $1.00 |
| Q2017 | A | $2,645.71 |
| Q2026 | A | $473.90 |
| Q2028 | A | $3.28 |
| Q2043 | A | $44,024.60 |
| Q2049 | A | $470.40 |
| Q2050 | A | $349.30 |
| Q3027 | A | $53.89 |
| Q4195 | A | $99.93 |
| Q4196 | A | $104.48 |
| Q5101 | A | $0.61 |
| Q5103 | A | $51.32 |
| Q5104 | A | $54.65 |
| Q5105 | A | $1.02 |
| Q5106 | A | $10.18 |
| Q5107 | A | $69.77 |
| Q5108 | A | $332.55 |
| Q5110 | A | $0.69 |
| Q5111 | A | $359.21 |
| Q9950 | A | $19.74 |
| Q9968 | A | $4.11 |
| Q9991 | A | $1,674.80 |
| Q9992 | A | $1,674.80 |
| 90371 | A | $118.20 |
| 90375 | A | $301.73 |
| 90376 | A | $285.66 |
| 90378 | A | $1,205.05 |
| 90396 | A | $1,687.54 |
| 90634 | A | $29.53 |
| 90675 | A | $294.53 |
| 90676 | A | $130.01 |
| 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 2019 by the American Medical Association.

