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Revised January 2022 1st Quarter ASC Drug File

Effective 01.01.2022 – Revised 07.01.2022

HCPCS Code Status Indicator Amount
A9590 A $320.12
A9591 A $644.83
A9592 A $918.52
A9593 A $732.86
A9594 A $717.55
A9595 A $541.78
C9046 A $1.30
C9047 A $691.43
C9067 A $8.64
C9084 A $249.10
C9085 A $70.65
C9086 A $15.80
C9087 A $7.52
C9088 A $0.69
C9089 A $0.83
C9250 A $156.84
C9257 A $1.70
C9290 A $1.34
C9399 C $0.00
C9460 A $16.24
C9482 A $17.58
C9488 A $43.69
J0121 A $3.33
J0129 A $44.52
J0135 A $1,581.57
J0172 A $11.87
J0178 A $915.75
J0179 A $311.93
J0180 A $198.75
J0185 A $1.72
J0202 A $2,129.15
J0207 A $1,135.69
J0220 A $117.07
J0221 A $181.42
J0222 A $97.78
J0223 A $106.67
J0224 A $302.27
J0256 A $4.55
J0257 A $4.98
J0287 A $9.60
J0289 A $29.47
J0291 A $3.10
J0300 A $125.22
J0390 A $165.22
J0401 A $5.99
J0475 A $181.57
J0480 A $4,037.65
J0485 A $3.79
J0490 A $48.23
J0517 A $167.44
J0558 A $11.78
J0561 A $15.04
J0565 A $39.79
J0570 A $1,311.75
J0584 A $380.15
J0585 A $6.17
J0586 A $8.31
J0587 A $12.12
J0588 A $5.06
J0594 A $1.45
J0596 A $30.02
J0597 A $57.40
J0598 A $58.96
J0600 A $5,708.59
J0630 A $2,841.59
J0638 A $115.89
J0642 A $1.83
J0691 A $0.72
J0695 A $6.64
J0699 A $2.01
J0712 A $3.57
J0714 A $92.37
J0716 A $5,190.15
J0717 A $6.28
J0740 A $567.92
J0741 A $20.56
J0742 A $2.31
J0745 A $135.64
J0775 A $56.60
J0791 A $124.12
J0795 A $9.67
J0840 A $2,636.69
J0841 A $1,022.45
J0850 A $1,525.46
J0875 A $14.82
J0881 A $3.09
J0882 A $3.09
J0883 A $1.24
J0884 A $1.24
J0885 A $8.22
J0888 A $1.51
J0894 A $2.88
J0896 A $37.40
J0897 A $21.21
J1095 A $0.96
J1096 A $134.20
J1097 A $98.53
J1162 A $4,128.19
J1190 A $189.84
J1201 A $15.29
J1212 A $636.56
J1290 A $504.13
J1300 A $228.94
J1301 A $20.61
J1303 A $224.63
J1305 A $165.63
J1322 A $250.30
J1327 A $2.11
J1410 A $341.50
J1426 A $166.49
J1427 A $58.95
J1429 A $166.19
J1430 A $444.10
J1437 A $24.40
J1438 A $790.78
J1439 A $1.12
J1442 A $0.98
J1447 A $0.45
J1448 A $4.95
J1451 A $5.38
J1454 A $503.98
J1455 A $71.69
J1458 A $411.91
J1459 A $45.01
J1460 A $45.42
J1554 A $481.77
J1555 A $14.75
J1556 A $70.49
J1557 A $50.80
J1558 A $13.30
J1559 A $11.79
J1560 A $454.19
J1561 A $46.51
J1566 A $69.59
J1568 A $41.61
J1569 A $46.67
J1571 A $73.60
J1572 A $35.89
J1573 A $73.60
J1575 A $15.42
J1595 A $141.04
J1602 A $16.07
J1610 A $166.77
J1627 A $6.71
J1628 A $79.48
J1632 A $72.96
J1640 A $26.63
J1670 A $482.08
J1726 A $14.76
J1729 A $21.54
J1738 A $3.06
J1742 A $316.20
J1744 A $200.47
J1745 A $37.68
J1746 A $66.25
J1750 A $15.73
J1786 A $43.97
J1823 A $462.62
J1826 A $2,293.85
J1830 A $398.00
J1833 A $0.83
J1930 A $66.18
J1931 A $34.78
J1943 A $3.00
J1944 A $2.95
J1950 A $1,366.01
J1951 A $127.05
J2182 A $28.69
J2186 A $1.84
J2265 A $2.14
J2278 A $9.05
J2315 A $3.52
J2323 A $23.25
J2326 A $1,122.27
J2350 A $58.91
J2353 A $206.56
J2357 A $37.51
J2358 A $2.92
J2406 A $41.92
J2407 A $24.40
J2425 A $23.93
J2426 A $12.65
J2502 A $319.35
J2506 A $182.03
J2507 A $2,968.61
J2547 A $1.68
J2560 A $42.24
J2562 A $382.78
J2597 A $9.29
J2724 A $15.09
J2760 A $414.12
J2770 A $428.19
J2778 A $307.20
J2783 A $321.67
J2786 A $10.13
J2792 A $31.52
J2794 A $11.04
J2796 A $83.62
J2798 A $10.68
J2820 A $53.56
J2840 A $539.87
J2850 A $34.78
J2860 A $125.16
J2993 A $1,851.83
J2997 A $87.67
J3031 A $2.31
J3032 A $16.01
J3060 A $41.23
J3090 A $1.66
J3095 A $6.40
J3101 A $134.62
J3111 A $9.33
J3145 A $1.61
J3240 A $1,858.04
J3241 A $315.88
J3245 A $133.59
J3246 A $3.61
J3262 A $5.73
J3285 A $57.47
J3304 A $17.63
J3315 A $337.01
J3316 A $3,067.25
J3357 A $170.82
J3358 A $11.62
J3380 A $21.29
J3385 A $359.80
J3396 A $11.24
J3398 A $2,932.00
J7168 A $1.99
J7169 A $288.47
J7170 A $48.75
J7175 A $8.20
J7178 A $1.30
J7179 A $1.84
J7180 A $9.14
J7181 A $16.12
J7182 A $1.53
J7183 A $1.14
J7185 A $1.27
J7186 A $1.13
J7187 A $1.26
J7188 A $3.20
J7189 A $2.31
J7190 A $1.11
J7192 A $1.43
J7193 A $1.17
J7194 A $1.53
J7195 A $1.59
J7197 A $3.55
J7198 A $2.20
J7200 A $1.45
J7201 A $3.25
J7202 A $4.61
J7203 A $4.27
J7204 A $2.18
J7205 A $2.12
J7207 A $1.94
J7208 A $2.11
J7209 A $1.30
J7210 A $1.35
J7211 A $1.23
J7212 A $2.20
J7308 A $391.43
J7311 A $324.09
J7312 A $200.21
J7313 A $490.95
J7314 A $518.47
J7316 A $1,046.93
J7318 A $17.74
J7320 A $16.92
J7322 A $31.67
J7323 A $135.24
J7324 A $147.75
J7325 A $10.43
J7326 A $1,219.00
J7327 A $790.78
J7328 A $2.24
J7329 A $19.12
J7331 A $18.02
J7336 A $3.24
J7340 A $211.26
J7342 A $29.99
J7345 A $1.59
J7351 A $205.72
J7352 A $3,218.90
J7402 A $10.56
J7501 A $232.34
J7504 A $2,355.36
J7511 A $838.33
J7525 A $219.67
J8560 A $75.51
J8655 A $322.71
J8670 A $1.77
J9015 A $3,795.26
J9017 A $12.81
J9019 A $427.27
J9021 A $45.22
J9022 A $79.58
J9023 A $87.61
J9025 A $0.89
J9027 A $61.65
J9032 A $43.42
J9033 A $20.69
J9034 A $19.08
J9035 A $67.86
J9036 A $22.88
J9037 A $43.29
J9039 A $124.11
J9041 A $44.79
J9042 A $196.55
J9043 A $191.31
J9044 A $16.77
J9047 A $41.11
J9050 A $1,099.82
J9055 A $67.62
J9057 A $81.04
J9061 A $17.91
J9065 A $15.08
J9070 A $27.47
J9119 A $27.67
J9120 A $838.88
J9144 A $45.03
J9145 A $57.22
J9150 A $41.24
J9153 A $207.63
J9155 A $4.06
J9173 A $76.86
J9176 A $6.86
J9177 A $30.19
J9179 A $127.44
J9198 A $25.08
J9202 A $543.16
J9203 A $211.11
J9204 A $212.64
J9205 A $57.37
J9207 A $114.19
J9210 A $362.31
J9214 A $32.74
J9217 A $200.38
J9223 A $180.23
J9225 A $5,166.29
J9226 A $43,442.33
J9227 A $69.02
J9228 A $160.70
J9229 A $2,407.20
J9230 A $11.74
J9245 A $197.46
J9246 A $18.20
J9247 A $497.44
J9261 A $155.90
J9262 A $3.30
J9264 A $14.04
J9266 A $21,561.05
J9268 A $1,934.45
J9269 A $296.34
J9270 A $115.40
J9271 A $52.30
J9272 A $215.12
J9280 A $50.66
J9281 A $281.79
J9285 A $52.07
J9293 A $29.40
J9295 A $5.74
J9299 A $29.25
J9301 A $64.11
J9302 A $63.96
J9303 A $130.41
J9305 A $76.04
J9306 A $13.56
J9307 A $319.73
J9308 A $63.56
J9309 A $113.57
J9311 A $38.21
J9312 A $85.63
J9313 A $23.39
J9316 A $71.65
J9317 A $31.26
J9318 A $33.91
J9319 A $33.23
J9320 A $347.88
J9325 A $57.22
J9328 A $10.41
J9330 A $34.75
J9340 A $305.45
J9348 A $538.88
J9349 A $12.80
J9352 A $325.03
J9353 A $43.76
J9354 A $34.15
J9355 A $86.41
J9356 A $71.49
J9357 A $1,435.66
J9358 A $24.60
J9371 A $3,420.78
J9395 A $15.65
J9400 A $7.66
J9600 A $21,856.35
P9041 A $10.49
P9045 A $52.45
P9046 A $20.98
P9047 A $52.45
Q0138 A $1.09
Q0139 A $1.00
Q2017 A $2,645.71
Q2026 A $257.37
Q2028 A $2.49
Q2043 A $52,421.58
Q2049 A $311.04
Q2050 A $200.52
Q3027 A $54.84
Q5101 A $0.31
Q5103 A $40.57
Q5104 A $39.58
Q5106 A $8.13
Q5107 A $39.77
Q5108 A $204.14
Q5110 A $0.34
Q5111 A $202.10
Q5112 A $61.11
Q5113 A $48.50
Q5114 A $55.72
Q5115 A $57.35
Q5116 A $55.79
Q5117 A $47.41
Q5118 A $50.59
Q5119 A $56.37
Q5120 A $222.86
Q5121 A $45.30
Q5122 A $269.14
Q5123 A $64.33
Q9968 A $7.76
Q9991 A $1,787.03
Q9992 A $1,787.03
90371 A $135.59
90375 A $308.67
90376 A $356.33
90377 A $239.92
90378 A $1,185.67
90396 A $1,959.83
90675 A $341.95
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 2022 by the American Medical Association.

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