Revised January 2021 1st Quarter ASC Drug File
Effective 01.01.2021 – Revised 04.01.2022
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9591 | A | $626.58 |
| C9046 | A | $1.26 |
| C9047 | A | $691.29 |
| C9065 | A | $311.84 |
| C9067 | A | $8.64 |
| C9068 | A | $901.25 |
| C9069 | A | $42.63 |
| C9070 | A | $12.36 |
| C9071 | A | $58.09 |
| C9072 | A | $481.77 |
| C9122 | A | $10.25 |
| C9132 | A | $2.10 |
| C9248 | A | $2.87 |
| C9250 | A | $156.84 |
| C9257 | A | $1.88 |
| C9290 | A | $1.29 |
| C9399 | C | $0.00 |
| C9460 | A | $15.46 |
| C9462 | A | $0.29 |
| C9482 | A | $16.00 |
| C9488 | A | $36.17 |
| J0121 | A | $3.27 |
| J0129 | A | $56.87 |
| J0135 | A | $1,430.92 |
| J0178 | A | $921.76 |
| J0179 | A | $314.95 |
| J0180 | A | $189.29 |
| J0185 | A | $1.59 |
| J0202 | A | $2,017.45 |
| J0207 | A | $1,135.69 |
| J0220 | A | $117.07 |
| J0221 | A | $174.63 |
| J0222 | A | $97.68 |
| J0223 | A | $106.88 |
| J0256 | A | $4.52 |
| J0257 | A | $4.89 |
| J0287 | A | $9.37 |
| J0289 | A | $27.24 |
| J0291 | A | $3.07 |
| J0300 | A | $125.22 |
| J0390 | A | $165.22 |
| J0401 | A | $5.70 |
| J0475 | A | $172.78 |
| J0480 | A | $4,019.07 |
| J0485 | A | $3.79 |
| J0490 | A | $46.84 |
| J0517 | A | $171.30 |
| J0558 | A | $12.01 |
| J0561 | A | $15.10 |
| J0565 | A | $39.67 |
| J0570 | A | $1,204.99 |
| J0584 | A | $361.95 |
| J0585 | A | $6.06 |
| J0586 | A | $8.27 |
| J0587 | A | $11.97 |
| J0588 | A | $5.06 |
| J0594 | A | $2.13 |
| J0596 | A | $28.98 |
| J0597 | A | $54.33 |
| J0598 | A | $56.41 |
| J0600 | A | $5,594.42 |
| J0630 | A | $2,830.55 |
| J0638 | A | $113.26 |
| J0641 | A | $0.12 |
| J0642 | A | $1.87 |
| J0691 | A | $0.72 |
| J0693 | A | $0.97 |
| J0695 | A | $6.43 |
| J0712 | A | $3.35 |
| J0714 | A | $92.28 |
| J0716 | A | $5,063.56 |
| J0717 | A | $8.18 |
| J0740 | A | $590.29 |
| J0742 | A | $2.26 |
| J0745 | A | $135.64 |
| J0775 | A | $52.62 |
| J0791 | A | $122.43 |
| J0795 | A | $9.57 |
| J0840 | A | $2,908.21 |
| J0841 | A | $1,263.49 |
| J0850 | A | $1,467.02 |
| J0875 | A | $15.39 |
| J0881 | A | $3.56 |
| J0882 | A | $3.56 |
| J0883 | A | $1.45 |
| J0884 | A | $1.45 |
| J0885 | A | $8.82 |
| J0888 | A | $1.50 |
| J0894 | A | $3.43 |
| J0896 | A | $36.31 |
| J0897 | A | $20.11 |
| J1095 | A | $1.11 |
| J1096 | A | $139.47 |
| J1097 | A | $101.71 |
| J1162 | A | $3,969.27 |
| J1190 | A | $195.98 |
| J1201 | A | $15.39 |
| J1212 | A | $635.87 |
| J1290 | A | $492.12 |
| J1300 | A | $230.32 |
| J1301 | A | $19.90 |
| J1303 | A | $226.18 |
| J1322 | A | $245.34 |
| J1410 | A | $325.51 |
| J1429 | A | $166.53 |
| J1430 | A | $444.10 |
| J1437 | A | $25.38 |
| J1438 | A | $736.30 |
| J1439 | A | $1.13 |
| J1442 | A | $0.94 |
| J1447 | A | $0.46 |
| J1451 | A | $7.39 |
| J1453 | A | $0.42 |
| J1454 | A | $695.56 |
| J1455 | A | $82.27 |
| J1458 | A | $404.07 |
| J1459 | A | $42.43 |
| J1460 | A | $43.30 |
| J1555 | A | $13.94 |
| J1556 | A | $70.49 |
| J1557 | A | $48.89 |
| J1558 | A | $14.69 |
| J1559 | A | $11.09 |
| J1560 | A | $432.96 |
| J1561 | A | $43.67 |
| J1566 | A | $66.97 |
| J1568 | A | $41.63 |
| J1569 | A | $43.63 |
| J1571 | A | $65.61 |
| J1572 | A | $36.86 |
| J1573 | A | $66.75 |
| J1575 | A | $14.34 |
| J1595 | A | $153.12 |
| J1602 | A | $18.12 |
| J1610 | A | $194.42 |
| J1628 | A | $88.40 |
| J1632 | A | $76.14 |
| J1640 | A | $24.43 |
| J1670 | A | $469.95 |
| J1726 | A | $16.05 |
| J1729 | A | $21.54 |
| J1738 | A | $3.26 |
| J1740 | A | $41.54 |
| J1742 | A | $273.16 |
| J1744 | A | $245.96 |
| J1745 | A | $44.90 |
| J1746 | A | $64.05 |
| J1750 | A | $15.05 |
| J1786 | A | $43.38 |
| J1823 | A | $449.77 |
| J1826 | A | $2,293.85 |
| J1830 | A | $393.47 |
| J1833 | A | $0.78 |
| J1930 | A | $68.46 |
| J1931 | A | $33.12 |
| J1943 | A | $2.91 |
| J1944 | A | $2.90 |
| J1950 | A | $1,582.13 |
| J2182 | A | $28.86 |
| J2186 | A | $1.77 |
| J2248 | A | $1.09 |
| J2265 | A | $2.00 |
| J2278 | A | $8.48 |
| J2315 | A | $3.43 |
| J2323 | A | $22.39 |
| J2326 | A | $1,122.06 |
| J2350 | A | $57.33 |
| J2353 | A | $205.41 |
| J2357 | A | $37.42 |
| J2358 | A | $2.92 |
| J2407 | A | $23.82 |
| J2425 | A | $22.82 |
| J2426 | A | $12.12 |
| J2502 | A | $315.84 |
| J2504 | A | $1,471.85 |
| J2505 | A | $3,079.49 |
| J2507 | A | $2,771.29 |
| J2515 | A | $31.79 |
| J2547 | A | $1.60 |
| J2560 | A | $45.66 |
| J2562 | A | $365.02 |
| J2597 | A | $10.57 |
| J2724 | A | $15.08 |
| J2760 | A | $356.88 |
| J2770 | A | $458.83 |
| J2778 | A | $322.85 |
| J2783 | A | $306.14 |
| J2786 | A | $9.75 |
| J2792 | A | $29.40 |
| J2794 | A | $10.53 |
| J2796 | A | $79.11 |
| J2798 | A | $10.16 |
| J2820 | A | $47.75 |
| J2840 | A | $540.41 |
| J2850 | A | $34.78 |
| J2860 | A | $111.50 |
| J2941 | A | $36.54 |
| J2993 | A | $2,395.94 |
| J2997 | A | $87.43 |
| J3031 | A | $2.28 |
| J3032 | A | $15.60 |
| J3060 | A | $40.96 |
| J3090 | A | $1.59 |
| J3095 | A | $5.94 |
| J3101 | A | $129.27 |
| J3111 | A | $9.00 |
| J3145 | A | $1.53 |
| J3240 | A | $1,776.21 |
| J3241 | A | $315.88 |
| J3243 | A | $1.19 |
| J3245 | A | $132.71 |
| J3246 | A | $2.41 |
| J3262 | A | $5.47 |
| J3285 | A | $63.69 |
| J3304 | A | $18.01 |
| J3315 | A | $503.81 |
| J3316 | A | $3,044.01 |
| J3357 | A | $180.12 |
| J3358 | A | $11.95 |
| J3380 | A | $20.35 |
| J3385 | A | $346.63 |
| J3396 | A | $11.25 |
| J3398 | A | $2,915.24 |
| J7169 | A | $291.50 |
| J7170 | A | $47.75 |
| J7175 | A | $7.89 |
| J7178 | A | $1.26 |
| J7179 | A | $1.89 |
| J7180 | A | $8.78 |
| J7181 | A | $15.45 |
| J7182 | A | $1.29 |
| J7183 | A | $1.04 |
| J7185 | A | $1.23 |
| J7186 | A | $1.12 |
| J7187 | A | $1.22 |
| J7188 | A | $3.19 |
| J7189 | A | $2.26 |
| J7190 | A | $1.07 |
| J7192 | A | $1.35 |
| J7193 | A | $1.19 |
| J7194 | A | $1.48 |
| J7195 | A | $1.53 |
| J7197 | A | $3.48 |
| J7198 | A | $2.09 |
| J7200 | A | $1.46 |
| J7201 | A | $3.26 |
| J7202 | A | $4.46 |
| J7203 | A | $3.96 |
| J7204 | A | $2.25 |
| J7205 | A | $2.17 |
| J7207 | A | $1.85 |
| J7208 | A | $2.03 |
| J7209 | A | $1.26 |
| J7210 | A | $1.35 |
| J7211 | A | $1.22 |
| J7212 | A | $2.60 |
| J7308 | A | $388.42 |
| J7311 | A | $341.22 |
| J7312 | A | $199.85 |
| J7313 | A | $490.93 |
| J7314 | A | $496.42 |
| J7316 | A | $1,046.93 |
| J7318 | A | $17.23 |
| J7320 | A | $16.92 |
| J7322 | A | $31.67 |
| J7323 | A | $135.14 |
| J7324 | A | $128.55 |
| J7325 | A | $10.67 |
| J7326 | A | $1,219.00 |
| J7327 | A | $785.19 |
| J7328 | A | $2.18 |
| J7329 | A | $7.20 |
| J7331 | A | $18.02 |
| J7336 | A | $3.25 |
| J7340 | A | $213.76 |
| J7342 | A | $29.98 |
| J7345 | A | $1.52 |
| J7351 | A | $206.38 |
| J7352 | A | $3,218.90 |
| J7501 | A | $245.17 |
| J7504 | A | $2,257.65 |
| J7511 | A | $790.60 |
| J7525 | A | $212.22 |
| J8560 | A | $75.77 |
| J8655 | A | $270.65 |
| J8670 | A | $2.34 |
| J9015 | A | $3,795.26 |
| J9017 | A | $17.82 |
| J9019 | A | $427.27 |
| J9022 | A | $78.18 |
| J9023 | A | $85.33 |
| J9025 | A | $0.91 |
| J9027 | A | $30.18 |
| J9032 | A | $42.70 |
| J9033 | A | $24.58 |
| J9034 | A | $20.17 |
| J9035 | A | $75.16 |
| J9036 | A | $22.27 |
| J9039 | A | $118.12 |
| J9041 | A | $44.67 |
| J9042 | A | $182.08 |
| J9043 | A | $184.85 |
| J9044 | A | $21.10 |
| J9047 | A | $39.35 |
| J9050 | A | $1,743.25 |
| J9055 | A | $65.48 |
| J9057 | A | $79.09 |
| J9065 | A | $21.02 |
| J9070 | A | $31.16 |
| J9119 | A | $27.40 |
| J9120 | A | $934.16 |
| J9144 | A | $43.85 |
| J9145 | A | $56.04 |
| J9150 | A | $42.52 |
| J9153 | A | $201.69 |
| J9155 | A | $3.89 |
| J9173 | A | $77.05 |
| J9176 | A | $6.67 |
| J9177 | A | $27.96 |
| J9179 | A | $117.76 |
| J9198 | A | $39.14 |
| J9202 | A | $501.27 |
| J9203 | A | $205.36 |
| J9204 | A | $206.42 |
| J9205 | A | $54.31 |
| J9207 | A | $102.12 |
| J9210 | A | $393.16 |
| J9214 | A | $33.99 |
| J9217 | A | $228.93 |
| J9223 | A | $170.80 |
| J9225 | A | $4,586.21 |
| J9226 | A | $40,116.00 |
| J9227 | A | $66.37 |
| J9228 | A | $157.23 |
| J9229 | A | $2,341.30 |
| J9230 | A | $328.29 |
| J9245 | A | $228.79 |
| J9246 | A | $23.60 |
| J9261 | A | $151.89 |
| J9262 | A | $3.31 |
| J9264 | A | $13.43 |
| J9266 | A | $19,717.46 |
| J9268 | A | $2,001.90 |
| J9269 | A | $283.33 |
| J9270 | A | $115.40 |
| J9271 | A | $50.65 |
| J9280 | A | $54.24 |
| J9281 | A | $282.17 |
| J9285 | A | $52.07 |
| J9293 | A | $24.14 |
| J9295 | A | $5.74 |
| J9299 | A | $28.54 |
| J9301 | A | $63.54 |
| J9302 | A | $62.15 |
| J9303 | A | $124.17 |
| J9305 | A | $73.19 |
| J9306 | A | $12.99 |
| J9307 | A | $310.93 |
| J9308 | A | $61.66 |
| J9309 | A | $112.12 |
| J9311 | A | $39.90 |
| J9312 | A | $91.84 |
| J9313 | A | $22.48 |
| J9315 | A | $336.66 |
| J9316 | A | $72.71 |
| J9317 | A | $29.51 |
| J9320 | A | $348.73 |
| J9325 | A | $54.02 |
| J9328 | A | $10.38 |
| J9330 | A | $42.86 |
| J9340 | A | $454.82 |
| J9352 | A | $318.92 |
| J9354 | A | $32.85 |
| J9355 | A | $100.49 |
| J9356 | A | $74.59 |
| J9357 | A | $1,410.41 |
| J9358 | A | $24.13 |
| J9371 | A | $3,320.40 |
| J9395 | A | $54.77 |
| J9400 | A | $8.50 |
| J9600 | A | $21,856.35 |
| P9041 | A | $10.49 |
| P9045 | A | $52.45 |
| P9046 | A | $20.98 |
| P9047 | A | $52.45 |
| Q0138 | A | $0.93 |
| Q0139 | A | $0.93 |
| Q2017 | A | $2,645.71 |
| Q2026 | A | $257.37 |
| Q2028 | A | $2.49 |
| Q2043 | A | $49,649.41 |
| Q2049 | A | $311.04 |
| Q2050 | A | $298.80 |
| Q3027 | A | $54.42 |
| Q5101 | A | $0.41 |
| Q5103 | A | $43.06 |
| Q5104 | A | $42.09 |
| Q5105 | A | $0.86 |
| Q5106 | A | $8.55 |
| Q5107 | A | $56.73 |
| Q5108 | A | $248.16 |
| Q5110 | A | $0.52 |
| Q5111 | A | $267.79 |
| Q5112 | A | $88.17 |
| Q5113 | A | $86.43 |
| Q5114 | A | $73.21 |
| Q5115 | A | $68.50 |
| Q5116 | A | $74.17 |
| Q5117 | A | $72.50 |
| Q5118 | A | $59.47 |
| Q5119 | A | $67.32 |
| Q5120 | A | $297.96 |
| Q5121 | A | $51.50 |
| Q5122 | A | $336.90 |
| Q9968 | A | $6.20 |
| Q9991 | A | $1,737.26 |
| Q9992 | A | $1,737.26 |
| 90371 | A | $126.86 |
| 90375 | A | $271.37 |
| 90376 | A | $237.37 |
| 90377 | A | $231.65 |
| 90378 | A | $1,185.67 |
| 90385 | A | $151.41 |
| 90396 | A | $1,912.39 |
| 90675 | A | $318.06 |
| 90676 | A | $189.63 |
| 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 2021 by the American Medical Association.

