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Revised July 2022 3rd Quarter ASC Drug File

Effective 07.01.2022 – Revised 07.01.2023

HCPCS Code Status Indicator Amount
A9590 A $320.12
A9591 A $677.08
A9592 A $944.71
A9593 A $732.86
A9594 A $717.55
A9595 A $558.03
A9596 A $996.40
C9046 A $1.23
C9047 A $717.21
C9067 A $8.64
C9088 A $0.70
C9089 A $0.81
C9094 A $16.86
C9095 A $193.23
C9096 A $0.78
C9097 A $37.60
C9250 A $193.87
C9257 A $1.73
C9290 A $1.38
C9399 C $0.00
C9460 A $17.39
C9482 A $19.32
C9488 A $43.10
J0121 A $3.47
J0129 A $44.22
J0135 A $1,698.61
J0172 A $5.98
J0178 A $912.89
J0179 A $311.96
J0180 A $205.92
J0185 A $1.72
J0202 A $2,194.49
J0207 A $1,135.69
J0219 A $72.68
J0220 A $117.07
J0221 A $186.41
J0222 A $98.97
J0223 A $107.96
J0224 A $305.49
J0256 A $4.61
J0257 A $5.15
J0287 A $10.20
J0289 A $26.36
J0291 A $3.13
J0300 A $125.22
J0390 A $165.22
J0401 A $6.31
J0475 A $182.02
J0480 A $4,087.67
J0485 A $3.78
J0490 A $49.44
J0491 A $16.18
J0517 A $168.86
J0558 A $12.86
J0561 A $16.48
J0565 A $39.87
J0570 A $1,311.75
J0584 A $401.50
J0585 A $6.21
J0586 A $8.52
J0587 A $12.17
J0588 A $5.06
J0594 A $2.04
J0596 A $31.60
J0597 A $60.77
J0598 A $60.67
J0600 A $5,708.59
J0630 A $2,231.39
J0638 A $118.61
J0642 A $1.46
J0691 A $0.72
J0695 A $6.40
J0699 A $2.11
J0712 A $3.73
J0714 A $91.79
J0716 A $5,190.15
J0717 A $5.58
J0740 A $583.01
J0741 A $21.05
J0742 A $2.38
J0745 A $135.64
J0775 A $58.87
J0791 A $125.06
J0795 A $9.67
J0840 A $2,605.39
J0841 A $1,072.21
J0850 A $1,654.66
J0875 A $14.91
J0881 A $3.32
J0882 A $3.32
J0883 A $1.39
J0884 A $1.39
J0885 A $8.22
J0888 A $1.62
J0894 A $1.59
J0896 A $37.94
J0897 A $22.26
J1095 A $0.86
J1096 A $131.92
J1097 A $97.10
J1162 A $4,293.36
J1190 A $168.78
J1201 A $15.09
J1212 A $636.41
J1290 A $513.74
J1300 A $228.02
J1301 A $20.99
J1303 A $224.09
J1305 A $169.43
J1306 A $11.79
J1322 A $262.31
J1327 A $2.13
J1410 A $353.67
J1426 A $166.29
J1427 A $58.94
J1429 A $166.23
J1430 A $454.17
J1437 A $23.03
J1438 A $790.78
J1439 A $1.11
J1442 A $1.00
J1447 A $0.42
J1448 A $4.94
J1451 A $4.69
J1454 A $466.07
J1455 A $71.20
J1458 A $432.43
J1459 A $46.93
J1460 A $46.16
J1551 A $12.03
J1554 A $481.77
J1555 A $14.97
J1556 A $70.49
J1557 A $48.34
J1558 A $13.57
J1559 A $12.35
J1560 A $461.64
J1561 A $43.39
J1566 A $73.18
J1568 A $42.02
J1569 A $45.00
J1571 A $75.14
J1572 A $40.52
J1573 A $75.14
J1575 A $15.89
J1595 A $138.45
J1602 A $14.69
J1610 A $171.60
J1627 A $6.45
J1628 A $82.37
J1632 A $70.89
J1640 A $28.92
J1670 A $516.49
J1726 A $16.72
J1729 A $21.54
J1738 A $3.00
J1742 A $78.18
J1744 A $216.72
J1745 A $35.71
J1746 A $69.76
J1750 A $16.37
J1786 A $44.15
J1823 A $462.87
J1826 A $2,293.85
J1830 A $392.03
J1833 A $0.86
J1930 A $65.97
J1931 A $35.88
J1943 A $2.94
J1944 A $2.92
J1950 A $1,495.37
J1951 A $133.46
J2182 A $29.11
J2186 A $1.93
J2265 A $2.22
J2278 A $9.08
J2315 A $3.54
J2323 A $24.17
J2326 A $1,122.58
J2350 A $60.49
J2353 A $207.51
J2356 A $17.82
J2357 A $38.12
J2358 A $2.91
J2406 A $42.27
J2407 A $25.59
J2425 A $25.13
J2426 A $13.13
J2502 A $391.51
J2506 A $155.83
J2507 A $3,110.56
J2547 A $1.68
J2560 A $40.30
J2562 A $402.54
J2597 A $7.71
J2724 A $15.06
J2760 A $392.68
J2770 A $337.47
J2778 A $275.14
J2779 A $83.23
J2783 A $330.90
J2786 A $9.95
J2792 A $31.91
J2794 A $11.47
J2796 A $87.74
J2798 A $10.92
J2820 A $55.32
J2840 A $539.24
J2850 A $38.09
J2860 A $128.49
J2993 A $2,417.17
J2997 A $85.82
J2998 A $30.85
J3031 A $2.34
J3032 A $16.42
J3060 A $41.69
J3090 A $1.74
J3095 A $7.00
J3101 A $139.48
J3111 A $9.70
J3145 A $1.65
J3240 A $1,906.93
J3241 A $321.37
J3245 A $138.64
J3246 A $3.59
J3262 A $5.80
J3285 A $55.71
J3299 A $47.61
J3304 A $16.99
J3315 A $363.57
J3316 A $3,062.71
J3357 A $174.69
J3358 A $12.29
J3380 A $22.76
J3385 A $359.73
J3396 A $11.38
J3398 A $2,909.90
J7168 A $2.09
J7169 A $286.10
J7170 A $49.90
J7175 A $8.55
J7178 A $1.34
J7179 A $1.86
J7180 A $9.37
J7181 A $16.35
J7182 A $1.26
J7183 A $1.15
J7185 A $1.25
J7186 A $1.14
J7187 A $1.29
J7188 A $3.20
J7189 A $2.35
J7190 A $1.14
J7192 A $1.45
J7193 A $1.16
J7194 A $1.54
J7195 A $1.63
J7197 A $3.59
J7198 A $2.28
J7200 A $1.49
J7201 A $3.37
J7202 A $4.71
J7203 A $4.20
J7204 A $2.10
J7205 A $2.17
J7207 A $1.99
J7208 A $2.16
J7209 A $1.27
J7210 A $1.39
J7211 A $1.27
J7212 A $1.97
J7308 A $392.09
J7311 A $332.61
J7312 A $200.10
J7313 A $490.95
J7314 A $518.14
J7316 A $1,046.93
J7318 A $10.36
J7320 A $6.17
J7322 A $15.71
J7323 A $131.03
J7324 A $131.88
J7325 A $9.77
J7326 A $488.09
J7327 A $754.90
J7328 A $1.28
J7329 A $6.68
J7331 A $18.02
J7336 A $3.24
J7340 A $211.50
J7342 A $29.98
J7345 A $1.58
J7351 A $206.40
J7352 A $2,873.33
J7402 A $10.93
J7501 A $235.61
J7504 A $2,898.30
J7511 A $896.71
J7525 A $231.22
J8560 A $76.09
J8655 A $379.06
J8670 A $1.76
J9015 A $3,795.26
J9017 A $12.33
J9019 A $427.27
J9021 A $46.53
J9022 A $82.27
J9023 A $88.38
J9025 A $0.67
J9027 A $48.40
J9032 A $44.36
J9033 A $17.70
J9034 A $17.84
J9035 A $69.23
J9036 A $19.37
J9037 A $44.13
J9039 A $129.82
J9041 A $44.01
J9042 A $205.56
J9043 A $196.61
J9044 A $14.87
J9047 A $43.24
J9050 A $760.83
J9055 A $69.41
J9057 A $82.46
J9061 A $18.66
J9065 A $21.66
J9070 A $26.87
J9071 A $3.01
J9119 A $27.25
J9120 A $633.77
J9144 A $46.58
J9145 A $58.75
J9150 A $44.05
J9153 A $215.41
J9155 A $4.03
J9173 A $78.20
J9176 A $6.95
J9177 A $31.36
J9179 A $128.99
J9198 A $25.78
J9202 A $576.10
J9203 A $214.28
J9204 A $216.25
J9205 A $60.14
J9207 A $117.06
J9210 A $380.39
J9214 A $31.85
J9217 A $179.27
J9223 A $183.98
J9225 A $5,166.29
J9226 A $42,302.58
J9227 A $70.50
J9228 A $163.66
J9229 A $2,443.31
J9230 A $11.74
J9245 A $181.51
J9246 A $18.02
J9247 A $503.50
J9261 A $130.14
J9262 A $3.61
J9264 A $14.69
J9266 A $23,554.48
J9268 A $2,076.08
J9269 A $309.41
J9270 A $115.40
J9271 A $53.14
J9272 A $220.43
J9273 A $155.91
J9280 A $47.16
J9281 A $285.36
J9285 A $52.07
J9293 A $35.79
J9295 A $5.74
J9299 A $29.69
J9301 A $66.01
J9302 A $63.96
J9303 A $136.97
J9304 A $79.25
J9305 A $78.39
J9306 A $14.15
J9307 A $321.09
J9308 A $65.67
J9309 A $117.81
J9311 A $37.90
J9312 A $84.17
J9313 A $23.39
J9316 A $70.37
J9317 A $32.03
J9318 A $33.91
J9319 A $33.23
J9320 A $349.38
J9325 A $59.68
J9328 A $10.40
J9330 A $32.91
J9331 A $101.58
J9332 A $31.53
J9340 A $298.19
J9348 A $557.38
J9349 A $12.97
J9352 A $330.18
J9353 A $44.03
J9354 A $35.62
J9355 A $86.61
J9356 A $68.73
J9357 A $1,437.85
J9358 A $25.17
J9359 A $188.30
J9371 A $3,420.78
J9395 A $14.02
J9400 A $8.09
J9600 A $21,856.35
P9041 A $10.49
P9045 A $52.45
P9046 A $20.98
P9047 A $52.45
Q0138 A $0.70
Q0139 A $0.70
Q2017 A $2,645.71
Q2026 A $257.37
Q2028 A $2.49
Q2043 A $55,114.75
Q2049 A $311.04
Q2050 A $129.99
Q3027 A $56.07
Q5101 A $0.27
Q5103 A $33.26
Q5104 A $51.25
Q5106 A $8.40
Q5107 A $32.24
Q5108 A $165.66
Q5110 A $0.34
Q5111 A $171.87
Q5112 A $68.50
Q5113 A $42.96
Q5114 A $47.89
Q5115 A $48.34
Q5116 A $45.48
Q5117 A $38.49
Q5118 A $41.86
Q5119 A $44.03
Q5120 A $154.14
Q5121 A $38.65
Q5122 A $217.69
Q5123 A $49.84
Q9968 A $8.22
Q9991 A $1,858.61
Q9992 A $1,858.61
90371 A $138.87
90375 A $286.02
90376 A $353.49
90377 A $241.20
90378 A $1,185.67
90396 A $2,073.13
90675 A $291.79
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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