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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.

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