Revised April 2022 2nd Quarter ASC Drug File
Effective 04.01.2022 Revised 04.01.2023
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9590 | A | 320.12 |
| A9591 | A | 677.08 |
| A9592 | A | 918.36 |
| A9593 | A | 732.86 |
| A9594 | A | 717.55 |
| A9595 | A | 558.03 |
| C9046 | A | 1.25 |
| C9047 | A | 691.34 |
| C9067 | A | 8.64 |
| C9088 | A | 0.70 |
| C9089 | A | 0.83 |
| C9090 | A | 31.80 |
| C9091 | A | 101.58 |
| C9092 | A | 42.49 |
| C9093 | A | 82.40 |
| C9250 | A | 193.87 |
| C9257 | A | 1.74 |
| C9290 | A | 1.34 |
| C9399 | C | 0.00 |
| C9460 | A | 16.30 |
| C9482 | A | 17.58 |
| C9488 | A | 43.90 |
| J0121 | A | 3.30 |
| J0129 | A | 43.90 |
| J0135 | A | 1,698.61 |
| J0172 | A | 5.64 |
| J0178 | A | 914.20 |
| J0179 | A | 312.28 |
| J0180 | A | 198.74 |
| J0185 | A | 1.73 |
| J0202 | A | 2,149.00 |
| J0207 | A | 1,135.69 |
| J0219 | A | 72.71 |
| J0220 | A | 117.07 |
| J0221 | A | 181.57 |
| J0222 | A | 97.85 |
| J0223 | A | 106.66 |
| J0224 | A | 302.28 |
| J0256 | A | 4.54 |
| J0257 | A | 4.97 |
| J0287 | A | 9.70 |
| J0289 | A | 27.38 |
| J0291 | A | 3.14 |
| J0300 | A | 125.22 |
| J0390 | A | 165.22 |
| J0401 | A | 5.99 |
| J0475 | A | 179.65 |
| J0480 | A | 4,062.84 |
| J0485 | A | 3.78 |
| J0490 | A | 48.25 |
| J0491 | A | 16.21 |
| J0517 | A | 165.57 |
| J0558 | A | 11.78 |
| J0561 | A | 15.12 |
| J0565 | A | 39.87 |
| J0570 | A | 1,311.75 |
| J0584 | A | 380.10 |
| J0585 | A | 6.19 |
| J0586 | A | 8.40 |
| J0587 | A | 12.17 |
| J0588 | A | 5.06 |
| J0594 | A | 1.91 |
| J0596 | A | 30.11 |
| J0597 | A | 57.33 |
| J0598 | A | 58.96 |
| J0600 | A | 5,708.59 |
| J0630 | A | 2,644.43 |
| J0638 | A | 116.94 |
| J0642 | A | 1.32 |
| J0691 | A | 0.72 |
| J0695 | A | 6.40 |
| J0699 | A | 2.01 |
| J0712 | A | 3.57 |
| J0714 | A | 91.79 |
| J0716 | A | 4,377.00 |
| J0717 | A | 5.64 |
| J0740 | A | 546.20 |
| J0741 | A | 20.54 |
| J0742 | A | 2.31 |
| J0745 | A | 135.64 |
| J0775 | A | 58.79 |
| J0791 | A | 124.18 |
| J0795 | A | 9.67 |
| J0840 | A | 2,622.69 |
| J0841 | A | 918.85 |
| J0850 | A | 1,526.58 |
| J0875 | A | 14.47 |
| J0881 | A | 3.28 |
| J0882 | A | 3.28 |
| J0883 | A | 1.28 |
| J0884 | A | 1.28 |
| J0885 | A | 8.11 |
| J0888 | A | 1.56 |
| J0894 | A | 2.71 |
| J0896 | A | 37.40 |
| J0897 | A | 21.26 |
| J1095 | A | 0.92 |
| J1096 | A | 133.13 |
| J1097 | A | 99.20 |
| J1162 | A | 4,296.54 |
| J1190 | A | 181.22 |
| J1201 | A | 15.11 |
| J1212 | A | 636.55 |
| J1290 | A | 501.36 |
| J1300 | A | 228.52 |
| J1301 | A | 20.99 |
| J1303 | A | 224.77 |
| J1305 | A | 165.63 |
| J1322 | A | 250.30 |
| J1327 | A | 2.69 |
| J1410 | A | 341.49 |
| J1426 | A | 166.25 |
| J1427 | A | 58.94 |
| J1429 | A | 166.19 |
| J1430 | A | 457.18 |
| J1437 | A | 24.22 |
| J1438 | A | 790.78 |
| J1439 | A | 1.14 |
| J1442 | A | 0.99 |
| J1447 | A | 0.44 |
| J1448 | A | 4.95 |
| J1451 | A | 5.64 |
| J1454 | A | 464.38 |
| J1455 | A | 72.67 |
| J1458 | A | 411.92 |
| J1459 | A | 45.05 |
| J1460 | A | 46.43 |
| J1554 | A | 481.77 |
| J1555 | A | 14.74 |
| J1556 | A | 70.49 |
| J1557 | A | 50.73 |
| J1558 | A | 13.66 |
| J1559 | A | 11.79 |
| J1560 | A | 464.27 |
| J1561 | A | 43.04 |
| J1566 | A | 69.93 |
| J1568 | A | 41.82 |
| J1569 | A | 43.88 |
| J1571 | A | 76.11 |
| J1572 | A | 38.72 |
| J1573 | A | 76.11 |
| J1575 | A | 15.25 |
| J1595 | A | 140.40 |
| J1602 | A | 15.01 |
| J1610 | A | 169.74 |
| J1627 | A | 6.57 |
| J1628 | A | 81.24 |
| J1632 | A | 71.00 |
| J1640 | A | 26.63 |
| J1670 | A | 523.73 |
| J1726 | A | 16.47 |
| J1729 | A | 21.54 |
| J1738 | A | 2.98 |
| J1742 | A | 316.20 |
| J1744 | A | 211.17 |
| J1745 | A | 36.51 |
| J1746 | A | 66.49 |
| J1750 | A | 15.77 |
| J1786 | A | 43.88 |
| J1823 | A | 462.87 |
| J1826 | A | 2,293.85 |
| J1830 | A | 354.32 |
| J1833 | A | 0.84 |
| J1930 | A | 65.01 |
| J1931 | A | 34.78 |
| J1943 | A | 2.99 |
| J1944 | A | 2.93 |
| J1950 | A | 1,421.56 |
| J1951 | A | 126.43 |
| J2182 | A | 28.75 |
| J2186 | A | 1.84 |
| J2265 | A | 2.14 |
| J2278 | A | 9.00 |
| J2315 | A | 3.54 |
| J2323 | A | 23.06 |
| J2326 | A | 1,122.43 |
| J2350 | A | 58.49 |
| J2353 | A | 207.43 |
| J2357 | A | 37.27 |
| J2358 | A | 2.92 |
| J2406 | A | 42.38 |
| J2407 | A | 24.51 |
| J2425 | A | 23.93 |
| J2426 | A | 12.64 |
| J2502 | A | 364.14 |
| J2506 | A | 167.68 |
| J2507 | A | 2,985.85 |
| J2547 | A | 1.68 |
| J2560 | A | 41.73 |
| J2562 | A | 382.65 |
| J2597 | A | 8.27 |
| J2724 | A | 15.12 |
| J2760 | A | 377.73 |
| J2770 | A | 428.33 |
| J2778 | A | 281.88 |
| J2783 | A | 321.80 |
| J2786 | A | 10.23 |
| J2792 | A | 30.62 |
| J2794 | A | 11.05 |
| J2796 | A | 83.90 |
| J2798 | A | 10.67 |
| J2820 | A | 54.04 |
| J2840 | A | 539.54 |
| J2850 | A | 34.78 |
| J2860 | A | 128.53 |
| J2993 | A | 2,151.79 |
| J2997 | A | 88.28 |
| J3031 | A | 2.29 |
| J3032 | A | 16.01 |
| J3060 | A | 40.35 |
| J3090 | A | 1.66 |
| J3095 | A | 6.33 |
| J3101 | A | 134.76 |
| J3111 | A | 9.32 |
| J3145 | A | 1.66 |
| J3240 | A | 1,858.66 |
| J3241 | A | 315.88 |
| J3245 | A | 137.27 |
| J3246 | A | 3.51 |
| J3262 | A | 5.82 |
| J3285 | A | 56.81 |
| J3304 | A | 17.50 |
| J3315 | A | 347.65 |
| J3316 | A | 3,060.21 |
| J3357 | A | 166.35 |
| J3358 | A | 11.65 |
| J3380 | A | 21.72 |
| J3385 | A | 359.92 |
| J3396 | A | 11.24 |
| J3398 | A | 2,951.10 |
| J7168 | A | 2.09 |
| J7169 | A | 287.37 |
| J7170 | A | 48.68 |
| J7175 | A | 8.20 |
| J7178 | A | 1.34 |
| J7179 | A | 1.81 |
| J7180 | A | 9.38 |
| J7181 | A | 15.68 |
| J7182 | A | 1.29 |
| J7183 | A | 1.13 |
| J7185 | A | 1.26 |
| J7186 | A | 1.15 |
| J7187 | A | 1.29 |
| J7188 | A | 3.20 |
| J7189 | A | 2.30 |
| J7190 | A | 1.07 |
| J7192 | A | 1.43 |
| J7193 | A | 1.18 |
| J7194 | A | 1.53 |
| J7195 | A | 1.58 |
| J7197 | A | 3.36 |
| J7198 | A | 2.21 |
| J7200 | A | 1.46 |
| J7201 | A | 3.25 |
| J7202 | A | 4.70 |
| J7203 | A | 4.07 |
| J7204 | A | 2.07 |
| J7205 | A | 2.13 |
| J7207 | A | 1.93 |
| J7208 | A | 2.09 |
| J7209 | A | 1.24 |
| J7210 | A | 1.38 |
| J7211 | A | 1.22 |
| J7212 | A | 2.01 |
| J7308 | A | 392.02 |
| J7311 | A | 334.36 |
| J7312 | A | 200.12 |
| J7313 | A | 490.95 |
| J7314 | A | 518.33 |
| J7316 | A | 1,046.93 |
| J7318 | A | 17.74 |
| J7320 | A | 16.92 |
| J7322 | A | 31.67 |
| J7323 | A | 131.21 |
| J7324 | A | 154.75 |
| J7325 | A | 10.44 |
| J7326 | A | 1,219.00 |
| J7327 | A | 769.61 |
| J7328 | A | 2.24 |
| J7329 | A | 19.12 |
| J7331 | A | 18.02 |
| J7336 | A | 3.24 |
| J7340 | A | 211.40 |
| J7342 | A | 29.98 |
| J7345 | A | 1.59 |
| J7351 | A | 206.04 |
| J7352 | A | 2,873.33 |
| J7402 | A | 10.56 |
| J7501 | A | 237.87 |
| J7504 | A | 2,355.95 |
| J7511 | A | 842.94 |
| J7525 | A | 219.71 |
| J8560 | A | 75.52 |
| J8655 | A | 355.57 |
| J8670 | A | 1.71 |
| J9015 | A | 3,795.26 |
| J9017 | A | 14.21 |
| J9019 | A | 427.27 |
| J9021 | A | 46.53 |
| J9022 | A | 79.27 |
| J9023 | A | 87.48 |
| J9025 | A | 0.72 |
| J9027 | A | 49.37 |
| J9032 | A | 44.03 |
| J9033 | A | 19.37 |
| J9034 | A | 18.55 |
| J9035 | A | 69.49 |
| J9036 | A | 21.62 |
| J9037 | A | 43.16 |
| J9039 | A | 124.39 |
| J9041 | A | 44.70 |
| J9042 | A | 196.65 |
| J9043 | A | 190.95 |
| J9044 | A | 15.66 |
| J9047 | A | 41.34 |
| J9050 | A | 801.10 |
| J9055 | A | 67.64 |
| J9057 | A | 80.83 |
| J9061 | A | 17.90 |
| J9065 | A | 17.70 |
| J9070 | A | 23.88 |
| J9071 | A | 3.76 |
| J9119 | A | 27.62 |
| J9120 | A | 809.06 |
| J9144 | A | 44.88 |
| J9145 | A | 56.68 |
| J9150 | A | 39.58 |
| J9153 | A | 212.83 |
| J9155 | A | 4.05 |
| J9173 | A | 77.11 |
| J9176 | A | 6.86 |
| J9177 | A | 31.34 |
| J9179 | A | 129.35 |
| J9198 | A | 25.59 |
| J9202 | A | 549.64 |
| J9203 | A | 211.11 |
| J9204 | A | 213.20 |
| J9205 | A | 57.51 |
| J9207 | A | 114.38 |
| J9210 | A | 364.99 |
| J9214 | A | 31.86 |
| J9217 | A | 168.84 |
| J9223 | A | 180.49 |
| J9225 | A | 5,166.29 |
| J9226 | A | 42,802.12 |
| J9227 | A | 68.88 |
| J9228 | A | 160.83 |
| J9229 | A | 2,407.20 |
| J9230 | A | 11.74 |
| J9245 | A | 186.85 |
| J9246 | A | 19.05 |
| J9247 | A | 497.24 |
| J9261 | A | 136.94 |
| J9262 | A | 3.30 |
| J9264 | A | 14.19 |
| J9266 | A | 21,561.05 |
| J9268 | A | 2,065.32 |
| J9269 | A | 295.90 |
| J9270 | A | 115.40 |
| J9271 | A | 53.70 |
| J9272 | A | 215.19 |
| J9273 | A | 155.95 |
| J9280 | A | 48.87 |
| J9281 | A | 281.22 |
| J9285 | A | 52.07 |
| J9293 | A | 33.92 |
| J9295 | A | 5.74 |
| J9299 | A | 29.24 |
| J9301 | A | 63.82 |
| J9302 | A | 63.96 |
| J9303 | A | 130.79 |
| J9304 | A | 79.25 |
| J9305 | A | 76.38 |
| J9306 | A | 13.56 |
| J9307 | A | 321.09 |
| J9308 | A | 63.69 |
| J9309 | A | 113.57 |
| J9311 | A | 37.96 |
| J9312 | A | 85.44 |
| J9313 | A | 23.39 |
| J9316 | A | 70.86 |
| J9317 | A | 31.26 |
| J9318 | A | 33.91 |
| J9319 | A | 33.23 |
| J9320 | A | 348.84 |
| J9325 | A | 57.17 |
| J9328 | A | 10.41 |
| J9330 | A | 35.35 |
| J9340 | A | 306.84 |
| J9348 | A | 547.14 |
| J9349 | A | 12.78 |
| J9352 | A | 325.03 |
| J9353 | A | 43.68 |
| J9354 | A | 34.14 |
| J9355 | A | 88.60 |
| J9356 | A | 70.96 |
| J9357 | A | 1,412.23 |
| J9358 | A | 24.62 |
| J9359 | A | 186.83 |
| J9371 | A | 3,420.78 |
| J9395 | A | 11.61 |
| J9400 | A | 8.22 |
| 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 | 52,916.50 |
| Q2049 | A | 311.04 |
| Q2050 | A | 178.82 |
| Q3027 | A | 54.46 |
| Q5101 | A | 0.31 |
| Q5103 | A | 38.68 |
| Q5104 | A | 61.10 |
| Q5106 | A | 8.26 |
| Q5107 | A | 36.13 |
| Q5108 | A | 179.85 |
| Q5110 | A | 0.36 |
| Q5111 | A | 183.41 |
| Q5112 | A | 76.89 |
| Q5113 | A | 52.59 |
| Q5114 | A | 50.11 |
| Q5115 | A | 53.69 |
| Q5116 | A | 51.02 |
| Q5117 | A | 42.88 |
| Q5118 | A | 45.86 |
| Q5119 | A | 49.82 |
| Q5120 | A | 179.24 |
| Q5121 | A | 43.29 |
| Q5122 | A | 243.05 |
| Q5123 | A | 56.59 |
| Q9968 | A | 7.35 |
| Q9991 | A | 1,781.31 |
| Q9992 | A | 1,781.31 |
| 90371 | A | 138.92 |
| 90375 | A | 321.80 |
| 90376 | A | 332.82 |
| 90377 | A | 223.61 |
| 90378 | A | 1,185.67 |
| 90396 | A | 1,959.60 |
| 90675 | A | 293.59 |
| 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 2023 by the American Medical Association.

