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October 2019 4th Quarter ASC Drug File

Effective 10.01.2019 – Revised 07.01.2020

HCPCS Code Status Indicator Amount
A9586 A $3,028.84
A9587 A $68.70
A9588 A $424.53
C9041 A $291.50
C9043 A $4.08
C9046 A $0.86
C9047 A $683.55
C9132 A $2.00
C9248 A $2.77
C9250 A $164.84
C9257 A $2.03
C9290 A $1.25
C9293 A $328.86
C9399 C $0.00
C9407 A $311.06
C9460 A $15.38
C9462 A $0.47
C9482 A $9.99
C9488 A $31.56
J0121 A $3.49
J0122 A $0.96
J0129 A $54.32
J0135 A $1,371.14
J0178 A $952.47
J0180 A $183.43
J0185 A $2.21
J0202 A $1,917.04
J0207 A $1,003.59
J0220 A $141.14
J0221 A $171.05
J0222 A $98.32
J0256 A $4.55
J0257 A $4.82
J0287 A $6.18
J0289 A $26.09
J0291 A $3.22
J0300 A $56.62
J0401 A $5.70
J0475 A $169.51
J0480 A $3,799.93
J0485 A $3.78
J0490 A $44.82
J0517 A $168.50
J0558 A $10.89
J0561 A $13.82
J0565 A $39.83
J0567 A $93.51
J0570 A $1,303.53
J0584 A $353.21
J0585 A $6.12
J0586 A $8.43
J0587 A $11.99
J0588 A $5.05
J0593 A $76.34
J0594 A $4.58
J0596 A $28.22
J0597 A $51.31
J0598 A $57.03
J0599 A $9.67
J0600 A $5,594.42
J0606 A $2.60
J0630 A $2,661.05
J0637 A $6.85
J0638 A $111.01
J0641 A $0.40
J0695 A $5.60
J0712 A $3.19
J0714 A $92.05
J0716 A $4,822.43
J0717 A $8.02
J0725 A $22.62
J0740 A $623.27
J0775 A $48.76
J0795 A $9.04
J0840 A $3,285.19
J0841 A $1,264.42
J0850 A $1,129.15
J0875 A $14.95
J0878 A $0.33
J0881 A $3.85
J0882 A $3.85
J0883 A $1.19
J0884 A $1.19
J0885 A $11.03
J0894 A $7.49
J0897 A $19.28
J1095 A $1.19
J1096 A $151.41
J1097 A $112.35
J1162 A $3,780.19
J1190 A $194.34
J1212 A $586.51
J1290 A $493.74
J1300 A $230.48
J1301 A $19.49
J1303 A $226.28
J1322 A $241.45
J1327 A $4.29
J1364 A $75.76
J1410 A $308.93
J1428 A $167.36
J1430 A $444.10
J1438 A $685.56
J1439 A $1.10
J1442 A $0.96
J1447 A $0.57
J1451 A $8.54
J1453 A $1.97
J1454 A $416.87
J1455 A $82.27
J1458 A $397.92
J1459 A $40.12
J1460 A $39.91
J1555 A $13.79
J1556 A $70.52
J1557 A $45.82
J1559 A $10.44
J1560 A $399.09
J1561 A $38.95
J1566 A $61.20
J1568 A $35.68
J1569 A $37.47
J1571 A $60.06
J1572 A $35.48
J1573 A $60.06
J1575 A $14.56
J1595 A $163.40
J1602 A $21.36
J1610 A $199.27
J1627 A $2.74
J1628 A $100.21
J1640 A $23.72
J1670 A $432.66
J1726 A $22.40
J1740 A $43.48
J1742 A $278.77
J1743 A $542.89
J1744 A $377.08
J1745 A $63.39
J1746 A $60.16
J1750 A $14.41
J1786 A $42.94
J1826 A $2,785.97
J1830 A $386.24
J1833 A $0.78
J1930 A $62.32
J1931 A $32.14
J1943 A $2.86
J1944 A $2.78
J1950 A $1,269.23
J2062 A $15.38
J2182 A $29.72
J2186 A $1.79
J2265 A $1.81
J2278 A $7.91
J2315 A $3.25
J2320 A $21.69
J2323 A $20.24
J2325 A $74.80
J2326 A $1,101.83
J2350 A $57.42
J2353 A $206.57
J2355 A $163.98
J2357 A $36.78
J2407 A $23.78
J2425 A $21.28
J2426 A $11.63
J2469 A $7.93
J2502 A $303.03
J2504 A $367.96
J2505 A $4,429.63
J2507 A $2,512.55
J2515 A $37.02
J2547 A $1.64
J2562 A $347.71
J2597 A $12.14
J2724 A $15.10
J2760 A $377.57
J2770 A $417.49
J2778 A $352.17
J2783 A $289.82
J2786 A $9.62
J2792 A $29.78
J2794 A $10.04
J2796 A $74.28
J2797 A $0.94
J2798 A $9.87
J2820 A $43.44
J2840 A $541.13
J2850 A $34.78
J2860 A $103.06
J2993 A $2,634.53
J2997 A $87.64
J3031 A $2.51
J3060 A $40.08
J3090 A $1.49
J3095 A $5.74
J3101 A $121.83
J3111 A $8.95
J3145 A $1.47
J3240 A $1,695.12
J3243 A $1.57
J3245 A $136.49
J3246 A $6.92
J3262 A $4.96
J3285 A $63.85
J3300 A $3.85
J3304 A $18.88
J3315 A $258.74
J3316 A $2,897.33
J3357 A $191.39
J3358 A $12.04
J3380 A $19.86
J3385 A $345.52
J3396 A $11.08
J3397 A $218.33
J3398 A $2,923.67
J7170 A $47.35
J7175 A $7.51
J7177 A $1.14
J7178 A $1.20
J7179 A $1.83
J7180 A $8.47
J7181 A $15.52
J7182 A $1.31
J7183 A $0.97
J7185 A $1.27
J7186 A $1.06
J7187 A $1.16
J7188 A $3.18
J7189 A $2.15
J7190 A $1.07
J7192 A $1.25
J7193 A $1.15
J7194 A $1.47
J7195 A $1.50
J7196 A $103.35
J7197 A $3.32
J7198 A $1.90
J7200 A $1.32
J7201 A $3.11
J7202 A $4.29
J7203 A $3.99
J7205 A $2.08
J7207 A $1.74
J7208 A $2.02
J7209 A $1.24
J7210 A $1.36
J7211 A $1.26
J7308 A $390.98
J7311 A $341.62
J7312 A $200.03
J7313 A $490.87
J7314 A $491.13
J7316 A $1,046.93
J7318 A $17.23
J7320 A $16.92
J7321 A $81.57
J7322 A $31.67
J7323 A $145.08
J7324 A $143.40
J7325 A $11.41
J7326 A $1,166.00
J7327 A $769.51
J7328 A $2.18
J7329 A $7.20
J7336 A $3.15
J7342 A $29.97
J7345 A $1.45
J7501 A $238.19
J7504 A $2,066.02
J7511 A $768.56
J7525 A $211.84
J8560 A $75.36
J8562 A $504.98
J8600 A $12.00
J8655 A $245.74
J8670 A $2.12
J9015 A $4,964.62
J9017 A $44.31
J9019 A $414.83
J9022 A $77.01
J9023 A $82.97
J9025 A $1.16
J9027 A $61.69
J9030 A $2.82
J9032 A $40.07
J9033 A $27.84
J9034 A $22.85
J9035 A $81.18
J9036 A $24.36
J9039 A $113.40
J9041 A $44.69
J9042 A $162.44
J9043 A $173.67
J9044 A $25.04
J9047 A $37.60
J9050 A $3,039.01
J9055 A $62.05
J9057 A $79.42
J9065 A $19.00
J9070 A $34.14
J9098 A $81.42
J9119 A $27.45
J9120 A $1,098.20
J9145 A $53.95
J9150 A $46.74
J9151 A $0.32
J9153 A $192.31
J9155 A $3.97
J9171 A $0.87
J9173 A $74.64
J9176 A $6.50
J9179 A $114.27
J9202 A $497.72
J9203 A $199.23
J9204 A $200.87
J9205 A $49.91
J9207 A $91.07
J9210 A $780.05
J9213 A $169.33
J9214 A $34.24
J9217 A $224.70
J9225 A $4,085.61
J9226 A $36,647.60
J9228 A $153.13
J9229 A $2,270.31
J9230 A $328.29
J9245 A $610.88
J9261 A $152.48
J9262 A $3.11
J9264 A $12.51
J9266 A $17,566.89
J9268 A $1,968.61
J9269 A $258.96
J9270 A $6.12
J9271 A $49.39
J9280 A $87.75
J9285 A $52.13
J9293 A $27.39
J9295 A $5.74
J9299 A $27.81
J9301 A $62.86
J9302 A $60.09
J9303 A $119.07
J9305 A $69.47
J9306 A $12.29
J9307 A $291.26
J9308 A $58.42
J9311 A $43.53
J9312 A $94.67
J9313 A $22.08
J9315 A $297.59
J9320 A $349.70
J9325 A $51.47
J9328 A $10.39
J9330 A $53.14
J9340 A $404.28
J9352 A $312.91
J9354 A $31.36
J9355 A $106.62
J9356 A $80.26
J9357 A $1,438.59
J9371 A $3,080.04
J9395 A $94.87
J9400 A $8.37
J9600 A $21,397.87
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 $46,374.20
Q2049 A $470.40
Q2050 A $355.07
Q3027 A $53.58
Q4195 A $89.70
Q4196 A $104.83
Q5101 A $0.57
Q5103 A $49.25
Q5104 A $53.40
Q5105 A $0.96
Q5106 A $9.63
Q5107 A $69.77
Q5108 A $327.41
Q5110 A $0.64
Q5111 A $347.06
Q5114 A $90.67
Q5115 A $87.09
Q5117 A $90.67
Q9950 A $19.54
Q9968 A $6.40
Q9991 A $1,673.36
Q9992 A $1,673.36
90371 A $110.67
90375 A $280.64
90376 A $271.37
90378 A $1,205.05
90396 A $1,716.18
90634 A $28.90
90675 A $297.59
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.

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