Revised October 2022 4th Quarter ASC Drug File
Effective 10.01.2022 – Revised 07.01.2023
| HCPCS Code | Status Indicator | Amount |
|---|---|---|
| A9590 | A | $320.12 |
| A9591 | A | $677.08 |
| A9592 | A | $944.44 |
| A9593 | A | $732.86 |
| A9594 | A | $717.55 |
| A9595 | A | $558.03 |
| A9596 | A | $968.20 |
| A9602 | A | $528.80 |
| A9800 | A | $848.00 |
| C9046 | A | $1.11 |
| C9047 | A | $719.20 |
| C9067 | A | $8.64 |
| C9088 | A | $0.70 |
| C9089 | A | $0.81 |
| C9101 | A | $0.39 |
| C9142 | A | $74.02 |
| C9250 | A | $193.87 |
| C9257 | A | $1.74 |
| C9290 | A | $1.38 |
| C9399 | C | $0.00 |
| C9460 | A | $17.13 |
| C9482 | A | $18.93 |
| C9488 | A | $47.24 |
| J0121 | A | $3.49 |
| J0129 | A | $43.25 |
| J0135 | A | $1,698.61 |
| J0172 | A | $5.98 |
| J0178 | A | $903.00 |
| J0179 | A | $313.79 |
| J0180 | A | $207.86 |
| J0185 | A | $1.68 |
| J0202 | A | $2,207.16 |
| J0207 | A | $1,135.69 |
| J0219 | A | $72.57 |
| J0220 | A | $117.07 |
| J0221 | A | $188.31 |
| J0222 | A | $100.78 |
| J0223 | A | $109.88 |
| J0224 | A | $311.25 |
| J0256 | A | $4.57 |
| J0257 | A | $5.18 |
| J0287 | A | $10.31 |
| J0289 | A | $25.90 |
| J0291 | A | $3.23 |
| J0300 | A | $125.22 |
| J0390 | A | $165.22 |
| J0401 | A | $6.41 |
| J0475 | A | $182.29 |
| J0480 | A | $4,102.57 |
| J0485 | A | $3.78 |
| J0490 | A | $49.47 |
| J0491 | A | $16.16 |
| J0517 | A | $169.47 |
| J0558 | A | $13.17 |
| J0561 | A | $16.73 |
| J0565 | A | $39.90 |
| J0570 | A | $1,311.75 |
| J0584 | A | $402.43 |
| J0585 | A | $6.23 |
| J0586 | A | $8.63 |
| J0587 | A | $12.47 |
| J0588 | A | $5.05 |
| J0594 | A | $1.39 |
| J0596 | A | $31.61 |
| J0597 | A | $60.78 |
| J0598 | A | $60.72 |
| J0600 | A | $5,708.59 |
| J0630 | A | $1,777.34 |
| J0638 | A | $118.73 |
| J0642 | A | $1.35 |
| J0691 | A | $0.72 |
| J0695 | A | $6.35 |
| J0699 | A | $2.11 |
| J0712 | A | $3.74 |
| J0714 | A | $91.64 |
| J0716 | A | $4,583.51 |
| J0717 | A | $5.41 |
| J0740 | A | $617.57 |
| J0741 | A | $21.06 |
| J0742 | A | $2.38 |
| J0745 | A | $135.64 |
| J0775 | A | $62.41 |
| J0791 | A | $124.62 |
| J0795 | A | $9.67 |
| J0840 | A | $2,498.30 |
| J0841 | A | $1,083.26 |
| J0850 | A | $1,666.71 |
| J0875 | A | $15.16 |
| J0881 | A | $3.16 |
| J0882 | A | $3.16 |
| J0883 | A | $1.32 |
| J0884 | A | $1.32 |
| J0885 | A | $8.37 |
| J0888 | A | $1.56 |
| J0894 | A | $1.42 |
| J0896 | A | $37.93 |
| J0897 | A | $22.51 |
| J1095 | A | $0.81 |
| J1096 | A | $130.60 |
| J1097 | A | $96.89 |
| J1162 | A | $4,294.08 |
| J1190 | A | $156.70 |
| J1201 | A | $15.08 |
| J1212 | A | $636.54 |
| J1290 | A | $520.23 |
| J1300 | A | $227.70 |
| J1301 | A | $21.42 |
| J1302 | A | $17.01 |
| J1303 | A | $223.36 |
| J1305 | A | $172.25 |
| J1306 | A | $12.05 |
| J1322 | A | $262.67 |
| J1327 | A | $1.87 |
| J1410 | A | $355.49 |
| J1426 | A | $166.30 |
| J1427 | A | $58.86 |
| J1429 | A | $166.16 |
| J1430 | A | $456.86 |
| J1437 | A | $22.97 |
| J1438 | A | $790.78 |
| J1439 | A | $1.14 |
| J1442 | A | $0.99 |
| J1447 | A | $0.39 |
| J1448 | A | $5.01 |
| J1451 | A | $7.02 |
| J1454 | A | $430.02 |
| J1455 | A | $70.42 |
| J1458 | A | $432.71 |
| J1459 | A | $46.70 |
| J1460 | A | $46.76 |
| J1551 | A | $12.72 |
| J1554 | A | $481.77 |
| J1555 | A | $14.90 |
| J1556 | A | $70.49 |
| J1557 | A | $51.07 |
| J1558 | A | $13.78 |
| J1559 | A | $12.36 |
| J1560 | A | $467.56 |
| J1561 | A | $44.67 |
| J1566 | A | $74.00 |
| J1568 | A | $42.10 |
| J1569 | A | $45.23 |
| J1571 | A | $70.60 |
| J1572 | A | $39.87 |
| J1573 | A | $70.60 |
| J1575 | A | $15.89 |
| J1595 | A | $138.79 |
| J1602 | A | $14.08 |
| J1610 | A | $170.33 |
| J1627 | A | $6.07 |
| J1628 | A | $80.56 |
| J1632 | A | $70.90 |
| J1640 | A | $29.03 |
| J1670 | A | $537.77 |
| J1726 | A | $15.67 |
| J1729 | A | $21.54 |
| J1738 | A | $3.01 |
| J1742 | A | $277.36 |
| J1744 | A | $193.00 |
| J1745 | A | $35.02 |
| J1746 | A | $69.73 |
| J1750 | A | $16.53 |
| J1786 | A | $44.28 |
| J1823 | A | $462.87 |
| J1826 | A | $2,293.85 |
| J1830 | A | $389.92 |
| J1833 | A | $0.86 |
| J1930 | A | $63.68 |
| J1931 | A | $36.11 |
| J1932 | A | $60.89 |
| J1943 | A | $2.98 |
| J1944 | A | $2.97 |
| J1950 | A | $1,477.55 |
| J1951 | A | $134.12 |
| J1952 | A | $95.64 |
| J2182 | A | $29.31 |
| J2186 | A | $2.01 |
| J2265 | A | $2.35 |
| J2278 | A | $9.07 |
| J2315 | A | $3.74 |
| J2323 | A | $24.03 |
| J2326 | A | $1,122.07 |
| J2350 | A | $60.08 |
| J2353 | A | $206.96 |
| J2356 | A | $18.01 |
| J2357 | A | $38.65 |
| J2358 | A | $2.92 |
| J2406 | A | $41.53 |
| J2407 | A | $25.81 |
| J2425 | A | $25.12 |
| J2426 | A | $13.28 |
| J2502 | A | $377.03 |
| J2506 | A | $131.41 |
| J2507 | A | $3,143.50 |
| J2547 | A | $1.68 |
| J2560 | A | $44.93 |
| J2562 | A | $402.60 |
| J2597 | A | $7.61 |
| J2724 | A | $15.07 |
| J2760 | A | $413.47 |
| J2770 | A | $493.97 |
| J2777 | A | $38.06 |
| J2778 | A | $258.41 |
| J2779 | A | $80.87 |
| J2783 | A | $332.08 |
| J2786 | A | $10.11 |
| J2792 | A | $32.45 |
| J2794 | A | $11.59 |
| J2796 | A | $89.00 |
| J2798 | A | $11.16 |
| J2820 | A | $55.44 |
| J2840 | A | $539.30 |
| J2850 | A | $38.09 |
| J2860 | A | $132.00 |
| J2993 | A | $2,491.03 |
| J2997 | A | $88.03 |
| J2998 | A | $30.54 |
| J3031 | A | $2.21 |
| J3032 | A | $16.41 |
| J3060 | A | $41.90 |
| J3090 | A | $1.74 |
| J3095 | A | $6.69 |
| J3101 | A | $143.87 |
| J3111 | A | $9.80 |
| J3145 | A | $1.82 |
| J3240 | A | $1,926.71 |
| J3241 | A | $321.88 |
| J3245 | A | $139.28 |
| J3246 | A | $3.59 |
| J3262 | A | $6.16 |
| J3285 | A | $55.36 |
| J3299 | A | $47.61 |
| J3304 | A | $16.93 |
| J3315 | A | $373.79 |
| J3316 | A | $3,119.98 |
| J3357 | A | $162.85 |
| J3358 | A | $12.36 |
| J3380 | A | $22.30 |
| J3385 | A | $358.90 |
| J3396 | A | $11.52 |
| J3398 | A | $2,907.23 |
| J7168 | A | $2.09 |
| J7169 | A | $102.65 |
| J7170 | A | $49.76 |
| J7175 | A | $8.60 |
| J7178 | A | $1.34 |
| J7179 | A | $1.80 |
| J7180 | A | $9.40 |
| J7181 | A | $16.21 |
| J7182 | A | $1.13 |
| J7183 | A | $1.16 |
| J7185 | A | $1.26 |
| J7186 | A | $1.15 |
| J7187 | A | $1.30 |
| J7188 | A | $3.20 |
| J7189 | A | $2.35 |
| J7190 | A | $1.13 |
| J7192 | A | $1.47 |
| J7193 | A | $1.23 |
| J7194 | A | $1.57 |
| J7195 | A | $1.63 |
| J7197 | A | $3.50 |
| J7198 | A | $2.20 |
| J7200 | A | $1.54 |
| J7201 | A | $3.36 |
| J7202 | A | $4.76 |
| J7203 | A | $4.16 |
| J7204 | A | $2.10 |
| J7205 | A | $2.16 |
| J7207 | A | $2.04 |
| J7208 | A | $2.16 |
| J7209 | A | $1.32 |
| J7210 | A | $1.40 |
| J7211 | A | $1.31 |
| J7212 | A | $2.11 |
| J7308 | A | $393.46 |
| J7311 | A | $338.63 |
| J7312 | A | $200.07 |
| J7313 | A | $490.95 |
| J7314 | A | $518.34 |
| J7316 | A | $1,046.93 |
| J7318 | A | $9.27 |
| J7320 | A | $6.40 |
| J7322 | A | $16.83 |
| J7323 | A | $130.89 |
| J7324 | A | $149.47 |
| J7325 | A | $10.14 |
| J7326 | A | $492.23 |
| J7327 | A | $756.93 |
| J7328 | A | $1.18 |
| J7329 | A | $9.72 |
| J7331 | A | $18.02 |
| J7336 | A | $3.24 |
| J7340 | A | $216.47 |
| J7342 | A | $29.84 |
| J7345 | A | $1.62 |
| J7351 | A | $206.33 |
| J7352 | A | $2,873.33 |
| J7402 | A | $10.93 |
| J7501 | A | $236.79 |
| J7504 | A | $2,782.17 |
| J7511 | A | $902.62 |
| J7525 | A | $233.60 |
| J8560 | A | $76.03 |
| J8655 | A | $396.09 |
| J8670 | A | $1.74 |
| J9015 | A | $3,795.26 |
| J9017 | A | $15.37 |
| J9019 | A | $427.27 |
| J9021 | A | $46.53 |
| J9022 | A | $82.07 |
| J9023 | A | $88.18 |
| J9025 | A | $0.50 |
| J9027 | A | $28.77 |
| J9032 | A | $44.36 |
| J9033 | A | $16.53 |
| J9034 | A | $17.43 |
| J9035 | A | $69.72 |
| J9036 | A | $17.12 |
| J9037 | A | $44.25 |
| J9039 | A | $131.90 |
| J9041 | A | $24.66 |
| J9042 | A | $205.76 |
| J9043 | A | $195.65 |
| J9044 | A | $8.37 |
| J9047 | A | $44.03 |
| J9050 | A | $468.03 |
| J9055 | A | $69.09 |
| J9057 | A | $82.37 |
| J9061 | A | $18.90 |
| J9065 | A | $24.31 |
| J9070 | A | $21.92 |
| J9071 | A | $2.75 |
| J9119 | A | $27.26 |
| J9120 | A | $557.40 |
| J9144 | A | $46.76 |
| J9145 | A | $59.35 |
| J9150 | A | $46.55 |
| J9153 | A | $215.22 |
| J9155 | A | $4.08 |
| J9173 | A | $77.96 |
| J9176 | A | $6.95 |
| J9177 | A | $32.55 |
| J9179 | A | $125.68 |
| J9198 | A | $23.57 |
| J9202 | A | $572.72 |
| J9203 | A | $214.28 |
| J9204 | A | $216.39 |
| J9205 | A | $60.05 |
| J9207 | A | $116.74 |
| J9210 | A | $375.71 |
| J9214 | A | $32.57 |
| J9217 | A | $166.08 |
| J9223 | A | $184.22 |
| J9225 | A | $5,166.29 |
| J9226 | A | $44,066.82 |
| J9227 | A | $70.45 |
| J9228 | A | $163.10 |
| J9229 | A | $2,443.31 |
| J9230 | A | $11.74 |
| J9245 | A | $297.10 |
| J9246 | A | $16.34 |
| J9247 | A | $503.50 |
| J9261 | A | $127.39 |
| J9262 | A | $3.65 |
| J9264 | A | $12.19 |
| J9266 | A | $23,577.01 |
| J9268 | A | $2,206.44 |
| J9269 | A | $308.81 |
| J9270 | A | $115.40 |
| J9271 | A | $54.55 |
| J9272 | A | $220.75 |
| J9273 | A | $155.90 |
| J9274 | A | $198.86 |
| J9280 | A | $54.29 |
| J9281 | A | $285.10 |
| J9285 | A | $52.07 |
| J9293 | A | $53.34 |
| J9295 | A | $5.74 |
| J9298 | A | $180.64 |
| J9299 | A | $29.55 |
| J9301 | A | $67.35 |
| J9302 | A | $63.96 |
| J9303 | A | $139.67 |
| J9304 | A | $75.79 |
| J9305 | A | $47.75 |
| J9306 | A | $14.44 |
| J9307 | A | $321.09 |
| J9308 | A | $65.62 |
| J9309 | A | $118.11 |
| J9311 | A | $37.88 |
| J9312 | A | $82.25 |
| J9313 | A | $23.39 |
| J9316 | A | $69.85 |
| J9317 | A | $32.04 |
| J9318 | A | $33.91 |
| J9319 | A | $32.79 |
| J9320 | A | $332.98 |
| J9325 | A | $60.62 |
| J9328 | A | $10.40 |
| J9330 | A | $31.88 |
| J9331 | A | $104.51 |
| J9332 | A | $31.53 |
| J9340 | A | $299.07 |
| J9348 | A | $557.42 |
| J9349 | A | $12.97 |
| J9352 | A | $331.85 |
| J9353 | A | $44.17 |
| J9354 | A | $35.70 |
| J9355 | A | $84.40 |
| J9356 | A | $67.81 |
| J9357 | A | $1,444.92 |
| J9358 | A | $25.21 |
| J9359 | A | $188.98 |
| J9371 | A | $3,420.78 |
| J9395 | A | $11.05 |
| J9400 | A | $7.13 |
| J9600 | A | $22,490.02 |
| P9041 | A | $10.49 |
| P9045 | A | $52.45 |
| P9046 | A | $20.98 |
| P9047 | A | $52.45 |
| Q0138 | A | $0.53 |
| Q0139 | A | $0.53 |
| Q2017 | A | $2,645.71 |
| Q2026 | A | $257.37 |
| Q2028 | A | $2.49 |
| Q2043 | A | $53,505.53 |
| Q2049 | A | $311.04 |
| Q2050 | A | $111.99 |
| Q3027 | A | $54.83 |
| Q5101 | A | $0.27 |
| Q5103 | A | $30.95 |
| Q5104 | A | $48.65 |
| Q5106 | A | $8.13 |
| Q5107 | A | $30.31 |
| Q5108 | A | $141.11 |
| Q5110 | A | $0.40 |
| Q5111 | A | $163.60 |
| Q5112 | A | $63.12 |
| Q5113 | A | $52.97 |
| Q5114 | A | $45.32 |
| Q5115 | A | $53.02 |
| Q5116 | A | $40.01 |
| Q5117 | A | $32.70 |
| Q5118 | A | $38.66 |
| Q5119 | A | $39.74 |
| Q5120 | A | $135.55 |
| Q5121 | A | $36.42 |
| Q5122 | A | $171.38 |
| Q5123 | A | $48.60 |
| Q5125 | A | $0.81 |
| Q9968 | A | $8.08 |
| Q9991 | A | $1,842.18 |
| Q9992 | A | $1,842.18 |
| 90371 | A | $135.88 |
| 90375 | A | $213.24 |
| 90376 | A | $325.72 |
| 90377 | A | $235.66 |
| 90378 | A | $1,185.67 |
| 90396 | A | $2,074.27 |
| 90675 | A | $348.53 |
| 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.

