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.

