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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.

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