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Revised October 2020 4th QTR ASC Drug File

Effective 10.01.2020 – Revised 07.01.2021

HCPCS Code Status Indicator Amount
C9046 A $1.23
C9047 A $690.68
C9060 A $.75
C9062 A $43.34
C9064 A $275.22
C9065 A $329.46
C9066 A $28.79
C9067 A $8.64
C9122 A $10.25
C9132 A $2.09
C9250 A $156.84
C9257 A $1.91
C9290 A $1.29
C9399 C $0.00
C9460 A $15.32
C9462 A $.28
C9482 A $16.00
C9488 A $32.57
J0121 A $3.15
J0122 A $1.02
J0129 A $58.10
J0135 A $1430.92
J0178 A $928.24
J0179 A $311.99
J0180 A $188.99
J0185 A $1.73
J0202 A $1984.32
J0207 A $1135.69
J0220 A $73.81
J0221 A $174.49
J0222 A $97.84
J0223 A $106.88
J0256 A $4.36
J0257 A $4.83
J0287 A $9.36
J0289 A $26.56
J0291 A $3.11
J0300 A $95.16
J0401 A $5.70
J0475 A $171.59
J0480 A $4005.19
J0485 A $3.78
J0490 A $46.18
J0517 A $170.11
J0558 A $12.00
J0561 A $15.16
J0565 A $39.65
J0567 A $95.36
J0570 A $1207.16
J0584 A $361.90
J0585 A $6.08
J0586 A $8.15
J0587 A $11.93
J0588 A $5.02
J0593 A $78.65
J0594 A $3.41
J0596 A $29.11
J0597 A $54.13
J0598 A $56.20
J0599 A $9.92
J0600 A $5594.42
J0606 A $2.15
J0630 A $2839.22
J0638 A $113.24
J0641 A $.28
J0642 A $1.89
J0691 A $.72
J0695 A $6.49
J0712 A $3.32
J0714 A $92.00
J0716 A $5063.56
J0717 A $8.16
J0740 A $666.25
J0742 A $2.26
J0775 A $52.39
J0791 A $122.41
J0795 A $9.38
J0800 A $4013.24
J0840 A $3043.75
J0841 A $1264.21
J0850 A $1496.95
J0875 A $15.39
J0878 A $.16
J0881 A $3.72
J0882 A $3.72
J0883 A $1.31
J0884 A $1.31
J0885 A $9.11
J0894 A $4.26
J0896 A $36.32
J0897 A $20.12
J1095 A $1.11
J1096 A $139.55
J1162 A $3972.14
J1190 A $199.93
J1201 A $15.45
J1212 A $635.67
J1267 A $1.15
J1290 A $494.69
J1300 A $230.48
J1301 A $19.89
J1303 A $226.28
J1322 A $246.20
J1327 A $4.51
J1410 A $325.62
J1428 A $167.45
J1429 A $166.33
J1430 A $444.10
J1438 A $736.30
J1439 A $1.11
J1442 A $.93
J1447 A $.47
J1451 A $5.33
J1453 A $.79
J1454 A $695.77
J1455 A $82.27
J1458 A $405.76
J1459 A $41.50
J1460 A $42.93
J1555 A $14.02
J1557 A $53.66
J1558 A $14.22
J1559 A $10.86
J1560 A $429.26
J1561 A $42.19
J1566 A $68.30
J1568 A $41.23
J1569 A $43.20
J1571 A $63.40
J1572 A $40.38
J1573 A $65.96
J1575 A $14.49
J1595 A $157.42
J1602 A $19.00
J1610 A $211.79
J1628 A $93.12
J1632 A $76.91
J1640 A $24.44
J1670 A $476.57
J1726 A $15.88
J1729 A $10.81
J1738 A $3.26
J1740 A $51.00
J1742 A $316.20
J1743 A $542.92
J1744 A $276.57
J1745 A $47.62
J1746 A $63.62
J1750 A $15.01
J1786 A $43.38
J1826 A $2276.61
J1830 A $393.83
J1833 A $.78
J1930 A $68.48
J1931 A $33.10
J1943 A $2.86
J1944 A $2.85
J1950 A $1347.56
J2182 A $28.70
J2186 A $1.78
J2265 A $1.99
J2278 A $8.17
J2315 A $3.26
J2323 A $21.63
J2326 A $1122.51
J2350 A $57.38
J2353 A $205.88
J2355 A $1.34
J2357 A $37.70
J2407 A $23.80
J2425 A $22.81
J2426 A $12.10
J2502 A $332.59
J2504 A $1471.85
J2505 A $3571.68
J2507 A $2801.08
J2515 A $33.93
J2547 A $1.60
J2562 A $365.29
J2597 A $10.45
J2724 A $15.06
J2760 A $359.14
J2770 A $458.04
J2778 A $324.27
J2783 A $300.94
J2786 A $9.76
J2792 A $36.37
J2794 A $10.53
J2796 A $78.43
J2798 A $10.18
J2820 A $47.06
J2840 A $541.13
J2850 A $34.78
J2860 A $111.94
J2941 A $84.13
J2997 A $87.15
J3031 A $2.25
J3032 A $15.40
J3060 A $40.86
J3090 A $1.59
J3095 A $5.14
J3101 A $129.26
J3111 A $9.01
J3145 A $1.54
J3240 A $1740.23
J3241 A $315.88
J3243 A $1.38
J3245 A $135.67
J3246 A $2.19
J3262 A $5.40
J3285 A $62.81
J3304 A $18.20
J3315 A $385.61
J3316 A $3044.01
J3357 A $184.36
J3358 A $12.03
J3380 A $20.30
J3385 A $346.15
J3396 A $11.23
J3397 A $223.01
J3398 A $2883.20
J7169 A $291.50
J7170 A $47.47
J7175 A $7.88
J7177 A $1.07
J7178 A $1.24
J7179 A $1.78
J7180 A $8.77
J7181 A $15.53
J7182 A $1.33
J7183 A $1.02
J7185 A $1.31
J7186 A $1.14
J7187 A $1.21
J7188 A $3.19
J7189 A $2.25
J7190 A $1.02
J7192 A $1.38
J7193 A $1.16
J7194 A $1.49
J7195 A $1.53
J7196 A $103.35
J7197 A $3.50
J7198 A $2.05
J7200 A $1.46
J7201 A $3.25
J7202 A $4.44
J7203 A $4.01
J7204 A $2.29
J7205 A $2.17
J7207 A $1.87
J7208 A $2.02
J7209 A $1.36
J7210 A $1.34
J7308 A $394.75
J7311 A $340.62
J7312 A $199.76
J7313 A $490.87
J7314 A $491.13
J7316 A $1046.93
J7318 A $17.23
J7320 A $16.92
J7322 A $31.67
J7323 A $140.31
J7324 A $128.41
J7325 A $10.22
J7326 A $1219.00
J7327 A $694.58
J7328 A $2.18
J7329 A $7.20
J7331 A $4.39
J7332 A $25.92
J7336 A $3.25
J7340 A $213.10
J7342 A $29.97
J7345 A $1.53
J7351 A $200.85
J7501 A $227.93
J7504 A $2257.67
J7511 A $817.12
J7525 A $211.97
J8510 A $23.81
J8560 A $75.49
J8655 A $270.10
J8670 A $2.27
J9015 A $4964.62
J9017 A $22.06
J9019 A $427.27
J9022 A $78.28
J9023 A $84.70
J9025 A $.80
J9027 A $52.64
J9030 A $2.79
J9032 A $42.79
J9033 A $24.69
J9034 A $20.27
J9035 A $76.36
J9036 A $21.61
J9039 A $118.59
J9041 A $44.97
J9042 A $175.28
J9043 A $181.51
J9044 A $22.04
J9047 A $39.20
J9050 A $2016.27
J9055 A $64.41
J9057 A $78.99
J9065 A $19.57
J9070 A $29.67
J9098 A $492.92
J9119 A $27.40
J9120 A $1044.53
J9145 A $56.29
J9150 A $43.84
J9153 A $197.79
J9155 A $3.84
J9171 A $.85
J9173 A $76.02
J9176 A $6.67
J9177 A $27.96
J9179 A $117.66
J9202 A $503.59
J9203 A $205.38
J9204 A $203.88
J9205 A $54.33
J9207 A $101.19
J9210 A $441.59
J9213 A $407.24
J9214 A $34.35
J9217 A $224.45
J9225 A $4558.13
J9226 A $40237.00
J9227 A $66.67
J9228 A $157.38
J9229 A $2341.50
J9230 A $328.29
J9245 A $260.38
J9246 A $26.96
J9261 A $152.15
J9262 A $2.98
J9264 A $13.30
J9266 A $19717.76
J9268 A $2060.28
J9269 A $270.59
J9271 A $50.85
J9280 A $49.88
J9285 A $52.07
J9293 A $28.69
J9295 A $5.73
J9299 A $28.56
J9301 A $63.74
J9302 A $61.94
J9303 A $123.55
J9305 A $71.95
J9306 A $12.95
J9307 A $311.22
J9308 A $60.71
J9309 A $110.72
J9311 A $41.14
J9312 A $92.56
J9313 A $22.46
J9315 A $336.54
J9320 A $349.54
J9325 A $53.92
J9328 A $10.38
J9330 A $44.99
J9340 A $475.39
J9352 A $318.93
J9354 A $32.79
J9355 A $99.68
J9356 A $75.08
J9357 A $1403.17
J9358 A $24.14
J9371 A $3320.17
J9395 A $52.74
J9400 A $8.07
J9600 A $21856.35
P9041 A $10.49
P9045 A $52.45
P9046 A $20.98
P9047 A $52.45
Q0138 A $.98
Q0139 A $.98
Q2009 A $1.61
Q2017 A $2645.71
Q2026 A $222.09
Q2028 A $3.19
Q2043 A $49671.77
Q2049 A $482.06
Q2050 A $315.73
Q3027 A $54.32
Q5101 A $.47
Q5103 A $43.72
Q5104 A $44.55
Q5105 A $.86
Q5106 A $8.61
Q5107 A $60.94
Q5108 A $269.04
Q5110 A $.62
Q5111 A $286.67
Q5112 A $92.30
Q5113 A $91.52
Q5114 A $76.41
Q5115 A $68.80
Q5116 A $83.10
Q5117 A $78.72
Q5118 A $62.24
Q5119 A $70.90
Q5120 A $305.55
Q5121 A $51.50
Q9968 A $7.55
Q9991 A $1743.48
Q9992 A $1743.48
90296 A $2957.76
90371 A $119.09
90375 A $273.04
90376 A $331.80
90378 A $1838.68
90396 A $1703.97
90675 A $303.24
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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