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.

