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Revised April 2021 2nd Quarter ASC Drug File

Effective 04.01.2021 – Revised 04.01.2022

HCPCS Code Status Indicator Amount
A9591 A $644.83
A9592 A $917.98
C9046 A $1.25
C9047 A $691.33
C9065 A $299.49
C9067 A $8.64
C9074 A $299.74
C9132 A $2.23
C9248 A $2.86
C9250 A $156.84
C9257 A $1.81
C9290 A $1.29
C9399 C $0.00
C9460 A $15.47
C9462 A $0.37
C9482 A $16.00
C9488 A $39.13
J0121 A $3.27
J0129 A $57.83
J0135 A $1,581.57
J0178 A $918.87
J0179 A $313.32
J0180 A $189.29
J0185 A $1.45
J0202 A $2,022.99
J0207 A $1,135.69
J0220 A $117.07
J0221 A $174.63
J0222 A $97.54
J0223 A $106.78
J0256 A $4.51
J0257 A $4.87
J0287 A $9.37
J0289 A $27.07
J0291 A $3.18
J0300 A $125.22
J0390 A $165.22
J0401 A $5.70
J0475 A $179.01
J0480 A $4,016.82
J0485 A $3.79
J0490 A $46.87
J0517 A $169.05
J0558 A $12.06
J0561 A $15.23
J0565 A $39.66
J0570 A $1,285.78
J0584 A $361.94
J0585 A $6.06
J0586 A $8.25
J0587 A $11.97
J0588 A $5.06
J0594 A $2.20
J0596 A $29.09
J0597 A $54.26
J0598 A $56.55
J0599 A $9.95
J0600 A $5,592.56
J0630 A $2,801.01
J0638 A $113.32
J0641 A $0.12
J0642 A $1.63
J0691 A $0.72
J0693 A $0.97
J0695 A $6.36
J0712 A $3.36
J0714 A $92.45
J0716 A $5,063.56
J0717 A $8.08
J0740 A $623.28
J0742 A $2.25
J0745 A $135.64
J0775 A $54.44
J0791 A $122.43
J0795 A $9.67
J0840 A $2,913.13
J0841 A $1,261.06
J0850 A $1,467.02
J0875 A $15.52
J0881 A $3.31
J0882 A $3.31
J0883 A $1.40
J0884 A $1.40
J0885 A $8.54
J0888 A $1.54
J0894 A $3.46
J0896 A $36.29
J0897 A $20.09
J1095 A $1.04
J1096 A $136.60
J1097 A $98.60
J1162 A $4,123.75
J1190 A $207.49
J1201 A $15.53
J1212 A $637.16
J1290 A $492.44
J1300 A $230.06
J1301 A $20.29
J1303 A $226.07
J1322 A $245.34
J1364 A $76.71
J1410 A $325.46
J1427 A $59.78
J1429 A $166.31
J1430 A $444.10
J1437 A $25.38
J1438 A $790.78
J1439 A $1.11
J1442 A $0.95
J1447 A $0.45
J1451 A $4.50
J1453 A $0.34
J1454 A $641.25
J1455 A $82.68
J1458 A $403.99
J1459 A $43.03
J1460 A $43.18
J1554 A $481.77
J1555 A $14.01
J1556 A $70.49
J1557 A $49.45
J1558 A $14.98
J1559 A $11.23
J1560 A $431.76
J1561 A $46.52
J1566 A $64.22
J1568 A $42.02
J1569 A $46.11
J1571 A $65.46
J1572 A $36.08
J1573 A $66.59
J1575 A $14.73
J1595 A $150.98
J1602 A $17.15
J1610 A $203.80
J1628 A $84.21
J1632 A $75.93
J1640 A $24.44
J1670 A $452.25
J1726 A $15.02
J1729 A $21.54
J1738 A $3.25
J1740 A $38.55
J1742 A $262.41
J1744 A $216.24
J1745 A $41.95
J1746 A $64.21
J1750 A $15.07
J1786 A $43.44
J1823 A $454.23
J1826 A $2,293.85
J1830 A $396.75
J1833 A $0.76
J1930 A $66.73
J1931 A $33.12
J1943 A $2.91
J1944 A $2.91
J1950 A $1,268.00
J2182 A $28.55
J2186 A $1.76
J2248 A $1.00
J2265 A $2.00
J2278 A $8.40
J2315 A $3.43
J2323 A $22.29
J2326 A $1,121.52
J2350 A $57.24
J2353 A $205.04
J2357 A $37.17
J2358 A $2.92
J2407 A $23.63
J2425 A $22.86
J2426 A $12.10
J2502 A $340.23
J2504 A $4.06
J2505 A $2,808.06
J2507 A $2,799.66
J2515 A $33.91
J2547 A $1.64
J2560 A $45.51
J2562 A $365.16
J2597 A $10.09
J2724 A $15.15
J2760 A $413.36
J2770 A $459.04
J2778 A $312.26
J2783 A $307.11
J2786 A $9.97
J2792 A $31.57
J2794 A $10.53
J2796 A $78.92
J2798 A $10.17
J2820 A $48.41
J2840 A $540.39
J2850 A $34.78
J2860 A $121.93
J2941 A $36.54
J2993 A $2,766.26
J2997 A $87.68
J3031 A $2.26
J3032 A $15.61
J3060 A $41.08
J3090 A $1.59
J3095 A $5.85
J3101 A $129.17
J3111 A $8.99
J3145 A $1.59
J3240 A $1,774.33
J3241 A $315.88
J3243 A $1.11
J3245 A $135.76
J3246 A $2.95
J3262 A $5.51
J3285 A $61.47
J3304 A $17.89
J3315 A $515.49
J3316 A $3,044.01
J3357 A $171.18
J3358 A $11.63
J3380 A $20.67
J3385 A $346.46
J3396 A $11.25
J3398 A $2,934.69
J7169 A $291.30
J7170 A $47.56
J7175 A $7.89
J7178 A $1.30
J7179 A $1.88
J7180 A $9.10
J7181 A $15.36
J7182 A $1.25
J7183 A $1.09
J7185 A $1.26
J7186 A $1.12
J7187 A $1.26
J7188 A $3.19
J7189 A $2.26
J7190 A $1.01
J7192 A $1.35
J7193 A $1.16
J7194 A $1.49
J7195 A $1.56
J7197 A $3.31
J7198 A $2.10
J7200 A $1.40
J7201 A $3.25
J7202 A $4.59
J7203 A $3.96
J7204 A $2.24
J7205 A $2.18
J7207 A $1.86
J7208 A $2.03
J7209 A $1.32
J7210 A $1.37
J7211 A $1.23
J7212 A $2.60
J7308 A $393.00
J7311 A $341.19
J7312 A $200.06
J7313 A $490.95
J7314 A $502.02
J7316 A $1,046.93
J7318 A $17.23
J7320 A $16.92
J7322 A $31.67
J7323 A $138.53
J7324 A $131.50
J7325 A $10.16
J7326 A $1,219.00
J7327 A $709.05
J7328 A $2.18
J7329 A $19.12
J7331 A $18.02
J7336 A $3.25
J7340 A $212.12
J7342 A $29.98
J7345 A $1.51
J7351 A $206.55
J7352 A $3,218.90
J7402 A $10.25
J7501 A $244.21
J7504 A $2,249.84
J7511 A $794.99
J7525 A $212.28
J8560 A $75.96
J8655 A $304.13
J8670 A $2.01
J9015 A $3,795.26
J9017 A $23.70
J9019 A $427.27
J9022 A $78.15
J9023 A $84.88
J9025 A $0.78
J9027 A $38.50
J9032 A $42.61
J9033 A $23.98
J9034 A $19.58
J9035 A $72.51
J9036 A $20.19
J9037 A $42.97
J9039 A $117.35
J9041 A $45.05
J9042 A $182.06
J9043 A $184.06
J9044 A $21.60
J9047 A $39.12
J9050 A $1,724.36
J9055 A $65.17
J9057 A $79.26
J9065 A $19.62
J9070 A $30.89
J9119 A $27.39
J9120 A $840.45
J9144 A $43.75
J9145 A $55.66
J9150 A $42.37
J9153 A $202.64
J9155 A $4.00
J9173 A $76.70
J9176 A $6.67
J9177 A $29.04
J9179 A $117.91
J9198 A $33.91
J9202 A $538.24
J9203 A $205.34
J9204 A $206.94
J9205 A $54.23
J9207 A $111.86
J9210 A $374.02
J9214 A $34.13
J9217 A $204.07
J9223 A $174.72
J9225 A $4,845.14
J9226 A $41,773.13
J9227 A $66.22
J9228 A $156.72
J9229 A $2,341.09
J9230 A $328.29
J9245 A $324.74
J9246 A $22.44
J9261 A $151.90
J9262 A $3.31
J9264 A $13.35
J9266 A $19,717.46
J9268 A $2,002.91
J9269 A $284.21
J9270 A $115.40
J9271 A $51.62
J9280 A $42.76
J9281 A $282.23
J9285 A $52.07
J9293 A $30.85
J9295 A $5.74
J9299 A $28.49
J9301 A $63.08
J9302 A $62.23
J9303 A $123.87
J9305 A $72.92
J9306 A $13.02
J9307 A $310.91
J9308 A $61.37
J9309 A $113.57
J9311 A $38.80
J9312 A $89.14
J9313 A $23.39
J9315 A $336.63
J9316 A $73.54
J9317 A $29.49
J9320 A $347.62
J9325 A $54.09
J9328 A $10.40
J9330 A $40.39
J9340 A $499.79
J9349 A $12.66
J9352 A $318.91
J9354 A $32.90
J9355 A $93.68
J9356 A $72.31
J9357 A $1,409.62
J9358 A $23.98
J9371 A $3,320.42
J9395 A $45.10
J9400 A $7.52
J9600 A $21,856.35
P9041 A $10.49
P9045 A $52.45
P9046 A $20.98
P9047 A $52.45
Q0138 A $0.97
Q0139 A $0.97
Q2017 A $2,645.71
Q2026 A $257.37
Q2028 A $2.49
Q2043 A $51,363.25
Q2049 A $311.04
Q2050 A $308.82
Q3027 A $54.29
Q5101 A $0.38
Q5103 A $40.61
Q5104 A $40.88
Q5105 A $0.92
Q5106 A $9.19
Q5107 A $52.89
Q5108 A $236.46
Q5110 A $0.45
Q5111 A $251.30
Q5112 A $80.16
Q5113 A $81.99
Q5114 A $60.66
Q5115 A $62.06
Q5116 A $68.11
Q5117 A $66.29
Q5118 A $57.34
Q5119 A $64.51
Q5120 A $276.82
Q5121 A $50.06
Q5122 A $336.90
Q9968 A $6.97
Q9991 A $1,736.54
Q9992 A $1,736.54
90371 A $126.28
90375 A $336.55
90376 A $310.58
90377 A $258.07
90378 A $1,185.67
90385 A $151.41
90396 A $1,874.14
90675 A $347.18
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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