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Revised April 2020 2nd QTR ASC Drug File

Effective 04.01.2020

HCPCS Code Status Indicator Amount
A9586 A $3,028.84
A9590 A $320.12
C9041 A $291.50
C9046 A $1.21
C9047 A $689.39
C9053 A $24.28
C9054 A $0.72
C9055 A $76.88
C9056 A $106.27
C9057 A $30.90
C9058 A $336.94
C9132 A $2.01
C9250 A $156.84
C9257 A $1.99
C9290 A $1.25
C9399 C $0.00
C9460 A $15.31
C9462 A $0.49
C9482 A $9.99
C9488 A $31.31
J0121 A $3.31
J0122 A $1.02
J0129 A $55.08
J0135 A $1,472.60
J0178 A $938.44
J0179 A $317.58
J0180 A $183.78
J0185 A $2.05
J0202 A $1,949.60
J0207 A $980.14
J0220 A $73.81
J0221 A $171.21
J0222 A $98.21
J0256 A $4.43
J0257 A $4.90
J0287 A $9.20
J0289 A $27.23
J0291 A $3.19
J0300 A $95.16
J0401 A $5.69
J0475 A $177.65
J0480 A $3,805.54
J0485 A $3.78
J0490 A $45.50
J0517 A $170.10
J0558 A $10.81
J0561 A $13.83
J0565 A $39.76
J0567 A $93.49
J0570 A $1,233.14
J0584 A $353.38
J0585 A $6.11
J0586 A $8.40
J0587 A $11.99
J0588 A $5.03
J0593 A $76.29
J0594 A $4.37
J0596 A $28.35
J0597 A $51.27
J0598 A $56.13
J0599 A $9.67
J0600 A $5,594.42
J0606 A $2.33
J0630 A $2,653.46
J0638 A $111.00
J0641 A $0.12
J0642 A $1.94
J0695 A $5.88
J0712 A $3.18
J0714 A $92.05
J0716 A $4,822.43
J0717 A $7.99
J0740 A $611.07
J0775 A $50.40
J0795 A $9.36
J0800 A $3,913.09
J0840 A $3,174.64
J0841 A $1,260.93
J0850 A $1,334.81
J0875 A $15.02
J0878 A $0.20
J0881 A $3.67
J0882 A $3.67
J0883 A $1.41
J0884 A $1.41
J0885 A $10.02
J0894 A $4.47
J0897 A $19.34
J1095 A $1.19
J1096 A $139.16
J1097 A $105.83
J1162 A $3,969.58
J1190 A $194.32
J1212 A $622.91
J1267 A $0.88
J1290 A $496.26
J1300 A $230.48
J1301 A $19.86
J1303 A $226.28
J1322 A $241.42
J1327 A $3.12
J1410 A $308.38
J1428 A $167.44
J1430 A $444.10
J1438 A $736.29
J1439 A $1.10
J1442 A $0.94
J1447 A $0.52
J1451 A $8.78
J1453 A $1.39
J1454 A $259.75
J1455 A $82.27
J1458 A $397.86
J1459 A $41.22
J1460 A $40.95
J1555 A $13.89
J1557 A $49.16
J1559 A $10.50
J1560 A $409.47
J1561 A $40.82
J1566 A $64.09
J1568 A $40.47
J1569 A $39.75
J1571 A $58.45
J1572 A $36.02
J1573 A $59.34
J1575 A $14.14
J1595 A $151.70
J1602 A $20.17
J1610 A $199.88
J1628 A $93.76
J1640 A $23.72
J1670 A $534.73
J1726 A $18.38
J1729 A $10.81
J1740 A $43.73
J1742 A $242.01
J1743 A $542.89
J1744 A $337.84
J1745 A $55.70
J1746 A $58.38
J1750 A $14.36
J1786 A $42.62
J1826 A $2,276.61
J1830 A $371.31
J1833 A $0.80
J1930 A $65.85
J1931 A $32.15
J1943 A $2.78
J1944 A $2.71
J1950 A $1,299.24
J2182 A $28.76
J2186 A $1.79
J2265 A $1.98
J2278 A $8.24
J2315 A $3.23
J2323 A $20.88
J2325 A $74.80
J2326 A $1,112.71
J2350 A $57.42
J2353 A $206.13
J2355 A $1.34
J2357 A $37.15
J2407 A $23.27
J2425 A $21.23
J2426 A $11.62
J2502 A $323.07
J2504 A $1,471.85
J2505 A $3,983.14
J2507 A $2,590.90
J2515 A $37.25
J2547 A $1.63
J2562 A $347.81
J2597 A $11.30
J2724 A $15.06
J2760 A $378.75
J2770 A $416.42
J2778 A $343.31
J2783 A $292.71
J2786 A $9.79
J2792 A $28.74
J2794 A $10.05
J2796 A $74.66
J2797 A $0.94
J2798 A $9.77
J2820 A $46.77
J2840 A $541.13
J2850 A $34.78
J2860 A $113.43
J2941 A $84.13
J2997 A $87.70
J3031 A $2.34
J3060 A $39.69
J3090 A $1.56
J3095 A $5.27
J3101 A $125.55
J3111 A $9.04
J3145 A $1.50
J3240 A $1,700.91
J3243 A $1.62
J3245 A $134.88
J3246 A $5.22
J3262 A $5.09
J3285 A $61.64
J3304 A $18.63
J3315 A $268.43
J3316 A $2,967.91
J3357 A $185.77
J3358 A $11.87
J3380 A $20.17
J3385 A $345.73
J3396 A $11.11
J3397 A $218.73
J3398 A $2,909.17
J7170 A $47.31
J7175 A $7.52
J7177 A $1.09
J7178 A $1.24
J7179 A $1.85
J7180 A $8.80
J7181 A $15.32
J7182 A $1.29
J7183 A $1.06
J7185 A $1.26
J7186 A $1.08
J7187 A $1.21
J7188 A $3.19
J7189 A $2.17
J7190 A $1.05
J7192 A $1.27
J7193 A $1.16
J7194 A $1.51
J7195 A $1.52
J7196 A $103.35
J7197 A $3.61
J7198 A $1.93
J7200 A $1.37
J7201 A $3.13
J7202 A $4.45
J7203 A $3.98
J7205 A $2.10
J7207 A $1.72
J7208 A $2.01
J7209 A $1.32
J7210 A $1.36
J7308 A $395.24
J7311 A $339.44
J7312 A $199.59
J7313 A $490.80
J7314 A $491.13
J7316 A $1,046.93
J7318 A $17.23
J7320 A $16.92
J7322 A $31.67
J7323 A $141.22
J7324 A $135.03
J7325 A $11.00
J7326 A $1,166.00
J7327 A $739.86
J7328 A $2.18
J7329 A $7.20
J7331 A $5.73
J7332 A $25.92
J7336 A $3.25
J7340 A $222.05
J7342 A $29.97
J7345 A $1.44
J7501 A $226.42
J7504 A $2,053.22
J7511 A $770.52
J7525 A $211.75
J8510 A $23.86
J8560 A $74.61
J8655 A $221.85
J8670 A $2.59
J9015 A $4,964.62
J9017 A $30.23
J9019 A $414.83
J9022 A $77.40
J9023 A $84.24
J9025 A $0.89
J9027 A $64.58
J9030 A $2.81
J9032 A $41.18
J9033 A $26.21
J9034 A $21.18
J9035 A $79.56
J9036 A $20.42
J9039 A $113.28
J9041 A $45.05
J9042 A $168.90
J9043 A $176.74
J9044 A $27.35
J9047 A $37.58
J9050 A $1,927.69
J9055 A $62.95
J9057 A $79.22
J9065 A $18.64
J9070 A $31.85
J9098 A $492.92
J9119 A $27.42
J9120 A $975.14
J9145 A $54.15
J9150 A $46.34
J9153 A $198.08
J9155 A $3.87
J9171 A $1.04
J9173 A $75.49
J9176 A $6.58
J9179 A $116.66
J9202 A $500.31
J9203 A $199.52
J9204 A $200.87
J9205 A $49.78
J9207 A $99.37
J9210 A $533.37
J9213 A $407.24
J9214 A $33.55
J9217 A $235.37
J9225 A $4,306.11
J9226 A $38,257.81
J9228 A $155.23
J9229 A $2,273.57
J9230 A $328.29
J9245 A $521.37
J9261 A $152.53
J9262 A $3.11
J9264 A $12.72
J9266 A $18,010.64
J9268 A $2,054.65
J9269 A $270.61
J9271 A $50.17
J9280 A $64.63
J9285 A $52.07
J9293 A $29.42
J9295 A $5.73
J9299 A $28.16
J9301 A $63.48
J9302 A $60.02
J9303 A $118.58
J9305 A $70.53
J9306 A $12.64
J9307 A $297.18
J9308 A $59.53
J9309 A $112.42
J9311 A $42.43
J9312 A $94.18
J9313 A $22.09
J9315 A $300.08
J9320 A $351.45
J9325 A $51.53
J9328 A $10.38
J9330 A $45.18
J9340 A $440.04
J9352 A $312.94
J9354 A $32.06
J9355 A $104.20
J9356 A $77.99
J9357 A $1,402.86
J9371 A $3,075.83
J9395 A $56.46
J9400 A $8.45
J9600 A $21,856.35
P9041 A $10.49
P9045 A $52.45
P9046 A $20.98
P9047 A $52.45
Q0138 A $1.07
Q0139 A $1.07
Q2009 A $1.84
Q2017 A $2,645.71
Q2026 A $222.09
Q2028 A $3.19
Q2043 A $47,986.31
Q2049 A $482.06
Q2050 A $304.72
Q3027 A $53.22
Q4195 A $113.56
Q4196 A $109.65
Q5101 A $0.49
Q5103 A $47.78
Q5104 A $49.00
Q5105 A $0.92
Q5106 A $9.21
Q5107 A $62.66
Q5108 A $307.52
Q5110 A $0.63
Q5111 A $321.85
Q5114 A $90.67
Q5115 A $87.09
Q5117 A $81.89
Q5118 A $63.18
Q9950 A $19.06
Q9968 A $6.49
Q9982 A $3,498.00
Q9983 A $2,968.00
Q9991 A $1,666.10
Q9992 A $1,666.10
90296 A $2,957.76
90371 A $117.83
90375 A $341.48
90376 A $226.80
90378 A $1,838.68
90396 A $1,705.32
90675 A $286.20
90676 A $227.53
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 2020 by the American Medical Association.

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