List of HCPCS codes for: Private Payer Codes (S-codes) - Group S0



HCPCS Code: S0012
Short Description: Butorphanol tartrate, nasal
Long Description: Butorphanol tartrate, nasal spray, 25 mg

HCPCS Code: S0014
Short Description: Tacrine hydrochloride, 10 mg
Long Description: Tacrine hydrochloride, 10 mg

HCPCS Code: S0017
Short Description: Injection, aminocaproic acid
Long Description: Injection, aminocaproic acid, 5 grams

HCPCS Code: S0020
Short Description: Injection, bupivicaine hydro
Long Description: Injection, bupivicaine hydrochloride, 30 ml

HCPCS Code: S0021
Short Description: Injection, cefoperazone sod
Long Description: Injection, cefoperazone sodium, 1 gram

HCPCS Code: S0023
Short Description: Injection, cimetidine hydroc
Long Description: Injection, cimetidine hydrochloride, 300 mg

HCPCS Code: S0028
Short Description: Injection, famotidine, 20 mg
Long Description: Injection, famotidine, 20 mg

HCPCS Code: S0030
Short Description: Injection, metronidazole
Long Description: Injection, metronidazole, 500 mg

HCPCS Code: S0032
Short Description: Injection, nafcillin sodium
Long Description: Injection, nafcillin sodium, 2 grams

HCPCS Code: S0034
Short Description: Injection, ofloxacin, 400 mg
Long Description: Injection, ofloxacin, 400 mg

HCPCS Code: S0039
Short Description: Injection, sulfamethoxazole
Long Description: Injection, sulfamethoxazole and trimethoprim, 10 ml

HCPCS Code: S0040
Short Description: Injection, ticarcillin disod
Long Description: Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams

HCPCS Code: S0073
Short Description: Injection, aztreonam, 500 mg
Long Description: Injection, aztreonam, 500 mg

HCPCS Code: S0074
Short Description: Injection, cefotetan disodiu
Long Description: Injection, cefotetan disodium, 500 mg

HCPCS Code: S0077
Short Description: Injection, clindamycin phosp
Long Description: Injection, clindamycin phosphate, 300 mg

HCPCS Code: S0078
Short Description: Injection, fosphenytoin sodi
Long Description: Injection, fosphenytoin sodium, 750 mg

HCPCS Code: S0080
Short Description: Injection, pentamidine iseth
Long Description: Injection, pentamidine isethionate, 300 mg

HCPCS Code: S0081
Short Description: Injection, piperacillin sodi
Long Description: Injection, piperacillin sodium, 500 mg

HCPCS Code: S0088
Short Description: Imatinib 100 mg
Long Description: Imatinib, 100 mg

HCPCS Code: S0090
Short Description: Sildenafil citrate, 25 mg
Long Description: Sildenafil citrate, 25 mg

HCPCS Code: S0091
Short Description: Granisetron 1mg
Long Description: Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166)

HCPCS Code: S0092
Short Description: Hydromorphone 250 mg
Long Description: Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump)

HCPCS Code: S0093
Short Description: Morphine 500 mg
Long Description: Injection, morphine sulfate, 500 mg (loading dose for infusion pump)

HCPCS Code: S0104
Short Description: Zidovudine, oral, 100 mg
Long Description: Zidovudine, oral, 100 mg

HCPCS Code: S0106
Short Description: Bupropion hcl sr 60 tablets
Long Description: Bupropion hcl sustained release tablet, 150 mg, per bottle of 60 tablets

HCPCS Code: S0108
Short Description: Mercaptopurine 50 mg
Long Description: Mercaptopurine, oral, 50 mg

HCPCS Code: S0109
Short Description: Methadone oral 5mg
Long Description: Methadone, oral, 5 mg

HCPCS Code: S0117
Short Description: Tretinoin topical 5 g
Long Description: Tretinoin, topical, 5 grams

HCPCS Code: S0119
Short Description: Ondansetron 4 mg
Long Description: Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code)

HCPCS Code: S0122
Short Description: Inj menotropins 75 iu
Long Description: Injection, menotropins, 75 iu

HCPCS Code: S0126
Short Description: Inj follitropin alfa 75 iu
Long Description: Injection, follitropin alfa, 75 iu

HCPCS Code: S0128
Short Description: Inj follitropin beta 75 iu
Long Description: Injection, follitropin beta, 75 iu

HCPCS Code: S0132
Short Description: Inj ganirelix acetat 250 mcg
Long Description: Injection, ganirelix acetate, 250 mcg

HCPCS Code: S0136
Short Description: Clozapine, 25 mg
Long Description: Clozapine, 25 mg

HCPCS Code: S0137
Short Description: Didanosine, 25 mg
Long Description: Didanosine (ddi), 25 mg

HCPCS Code: S0138
Short Description: Finasteride, 5 mg
Long Description: Finasteride, 5 mg

HCPCS Code: S0139
Short Description: Minoxidil, 10 mg
Long Description: Minoxidil, 10 mg

HCPCS Code: S0140
Short Description: Saquinavir, 200 mg
Long Description: Saquinavir, 200 mg

HCPCS Code: S0142
Short Description: Colistimethate inh sol mg
Long Description: Colistimethate sodium, inhalation solution administered through dme, concentrated form, per mg

HCPCS Code: S0144
Short Description: Inj, propofol, 10 mg
Long Description: Injection, propofol, 10 mg

HCPCS Code: S0145
Short Description: Peg interferon alfa-2a/180
Long Description: Injection, pegylated interferon alfa-2a, 180 mcg per ml

HCPCS Code: S0148
Short Description: Peg interferon alfa-2b/10
Long Description: Injection, pegylated interferon alfa-2b, 10 mcg

HCPCS Code: S0155
Short Description: Epoprostenol dilutant
Long Description: Sterile dilutant for epoprostenol, 50 ml

HCPCS Code: S0156
Short Description: Exemestane, 25 mg
Long Description: Exemestane, 25 mg

HCPCS Code: S0157
Short Description: Becaplermin gel 1%, 0.5 gm
Long Description: Becaplermin gel 0.01%, 0.5 gm

HCPCS Code: S0160
Short Description: Dextroamphetamine
Long Description: Dextroamphetamine sulfate, 5 mg

HCPCS Code: S0164
Short Description: Injection pantroprazole
Long Description: Injection, pantoprazole sodium, 40 mg

HCPCS Code: S0166
Short Description: Inj olanzapine 2.5mg
Long Description: Injection, olanzapine, 2.5 mg

HCPCS Code: S0169
Short Description: Calcitrol
Long Description: Calcitrol, 0.25 microgram

HCPCS Code: S0170
Short Description: Anastrozole 1 mg
Long Description: Anastrozole, oral, 1 mg

HCPCS Code: S0171
Short Description: Bumetanide 0.5 mg
Long Description: Injection, bumetanide, 0.5 mg

HCPCS Code: S0172
Short Description: Chlorambucil 2 mg
Long Description: Chlorambucil, oral, 2 mg

HCPCS Code: S0174
Short Description: Dolasetron 50 mg
Long Description: Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)

HCPCS Code: S0175
Short Description: Flutamide 125 mg
Long Description: Flutamide, oral, 125 mg

HCPCS Code: S0176
Short Description: Hydroxyurea 500 mg
Long Description: Hydroxyurea, oral, 500 mg

HCPCS Code: S0177
Short Description: Levamisole 50 mg
Long Description: Levamisole hydrochloride, oral, 50 mg

HCPCS Code: S0178
Short Description: Lomustine 10 mg
Long Description: Lomustine, oral, 10 mg

HCPCS Code: S0179
Short Description: Megestrol 20 mg
Long Description: Megestrol acetate, oral, 20 mg

HCPCS Code: S0182
Short Description: Procarbazine, oral
Long Description: Procarbazine hydrochloride, oral, 50 mg

HCPCS Code: S0183
Short Description: Prochlorperazine 5 mg
Long Description: Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164)

HCPCS Code: S0187
Short Description: Tamoxifen 10 mg
Long Description: Tamoxifen citrate, oral, 10 mg

HCPCS Code: S0189
Short Description: Testosterone pellet 75 mg
Long Description: Testosterone pellet, 75 mg

HCPCS Code: S0190
Short Description: Mifepristone, oral, 200 mg
Long Description: Mifepristone, oral, 200 mg

HCPCS Code: S0191
Short Description: Misoprostol, oral, 200 mcg
Long Description: Misoprostol, oral, 200 mcg

HCPCS Code: S0194
Short Description: Vitamin suppl 100 caps
Long Description: Dialysis/stress vitamin supplement, oral, 100 capsules

HCPCS Code: S0195
Short Description: Pneumo vaccine 5-9 yrs
Long Description: Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from five years to nine years of age who have not previously received the vaccine

HCPCS Code: S0197
Short Description: Prenatal vitamins 30 day
Long Description: Prenatal vitamins, 30-day supply

HCPCS Code: S0199
Short Description: Med abortion inc all ex drug
Long Description: Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs

HCPCS Code: S0201
Short Description: Partial hospitalization serv
Long Description: Partial hospitalization services, less than 24 hours, per diem

HCPCS Code: S0207
Short Description: Paramedicintercep nonhospals
Long Description: Paramedic intercept, non-hospital-based als service (non-voluntary), non-transport

HCPCS Code: S0208
Short Description: Paramed intrcept nonvol
Long Description: Paramedic intercept, hospital-based als service (non-voluntary), non-transport

HCPCS Code: S0209
Short Description: Wc van mileage per mi
Long Description: Wheelchair van, mileage, per mile

HCPCS Code: S0215
Short Description: Nonemerg transp mileage
Long Description: Non-emergency transportation; mileage, per mile

HCPCS Code: S0220
Short Description: Medical conference by physic
Long Description: Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care (patient is present); approximately 30 minutes

HCPCS Code: S0221
Short Description: Medical conference, 60 min
Long Description: Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care (patient is present); approximately 60 minutes

HCPCS Code: S0250
Short Description: Comp geriatr assmt team
Long Description: Comprehensive geriatric assessment and treatment planning performed by assessment team

HCPCS Code: S0255
Short Description: Hospice refer visit nonmd
Long Description: Hospice referral visit (advising patient and family of care options) performed by nurse, social worker, or other designated staff

HCPCS Code: S0257
Short Description: End of life counseling
Long Description: Counseling and discussion regarding advance directives or end of life care planning and decisions, with patient and/or surrogate (list separately in addition to code for appropriate evaluation and management service)

HCPCS Code: S0260
Short Description: H&p for surgery
Long Description: History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service)

HCPCS Code: S0265
Short Description: Genetic counsel 15 mins
Long Description: Genetic counseling, under physician supervision, each 15 minutes

HCPCS Code: S0270
Short Description: Home std case rate 30 days
Long Description: Physician management of patient home care, standard monthly case rate (per 30 days)

HCPCS Code: S0271
Short Description: Home hospice case 30 days
Long Description: Physician management of patient home care, hospice monthly case rate (per 30 days)

HCPCS Code: S0272
Short Description: Home episodic case 30 days
Long Description: Physician management of patient home care, episodic care monthly case rate (per 30 days)

HCPCS Code: S0273
Short Description: Md home visit outside cap
Long Description: Physician visit at member's home, outside of a capitation arrangement

HCPCS Code: S0274
Short Description: Nurse practr visit outs cap
Long Description: Nurse practitioner visit at member's home, outside of a capitation arrangement

HCPCS Code: S0280
Short Description: Medical home, initial plan
Long Description: Medical home program, comprehensive care coordination and planning, initial plan

HCPCS Code: S0281
Short Description: Medical home, maintenance
Long Description: Medical home program, comprehensive care coordination and planning, maintenance of plan

HCPCS Code: S0302
Short Description: Completed epsdt
Long Description: Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)

HCPCS Code: S0310
Short Description: Hospitalist visit
Long Description: Hospitalist services (list separately in addition to code for appropriate evaluation and management service)

HCPCS Code: S0315
Short Description: Disease management program
Long Description: Disease management program; initial assessment and initiation of the program

HCPCS Code: S0316
Short Description: Follow-up/reassessment
Long Description: Disease management program, follow-up/reassessment

HCPCS Code: S0317
Short Description: Disease mgmt per diem
Long Description: Disease management program; per diem

HCPCS Code: S0320
Short Description: Rn telephone calls to dmp
Long Description: Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month

HCPCS Code: S0340
Short Description: Lifestyle mod 1st stage
Long Description: Lifestyle modification program for management of coronary artery disease, including all supportive services; first quarter / stage

HCPCS Code: S0341
Short Description: Lifestyle mod 2 or 3 stage
Long Description: Lifestyle modification program for management of coronary artery disease, including all supportive services; second or third quarter / stage

HCPCS Code: S0342
Short Description: Lifestyle mod 4th stage
Long Description: Lifestyle modification program for management of coronary artery disease, including all supportive services; fourth quarter / stage

HCPCS Code: S0353
Short Description: Cancer treatmentplan initial
Long Description: Treatment planning and care coordination management for cancer, initial treatment

HCPCS Code: S0354
Short Description: Cancer treatment plan change
Long Description: Treatment planning and care coordination management for cancer, established patient with a change of regimen

HCPCS Code: S0390
Short Description: Rout foot care per visit
Long Description: Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit

HCPCS Code: S0395
Short Description: Impression casting ft
Long Description: Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic

HCPCS Code: S0400
Short Description: Global eswl kidney
Long Description: Global fee for extracorporeal shock wave lithotripsy treatment of kidney stone(s)

HCPCS Code: S0500
Short Description: Dispos cont lens
Long Description: Disposable contact lens, per lens

HCPCS Code: S0504
Short Description: Singl prscrp lens
Long Description: Single vision prescription lens (safety, athletic, or sunglass), per lens

HCPCS Code: S0506
Short Description: Bifoc prscp lens
Long Description: Bifocal vision prescription lens (safety, athletic, or sunglass), per lens

HCPCS Code: S0508
Short Description: Trifoc prscrp lens
Long Description: Trifocal vision prescription lens (safety, athletic, or sunglass), per lens

HCPCS Code: S0510
Short Description: Non-prscrp lens
Long Description: Non-prescription lens (safety, athletic, or sunglass), per lens

HCPCS Code: S0512
Short Description: Daily cont lens
Long Description: Daily wear specialty contact lens, per lens

HCPCS Code: S0514
Short Description: Color cont lens
Long Description: Color contact lens, per lens

HCPCS Code: S0515
Short Description: Scleral lens liquid bandage
Long Description: Scleral lens, liquid bandage device, per lens

HCPCS Code: S0516
Short Description: Safety frames
Long Description: Safety eyeglass frames

HCPCS Code: S0518
Short Description: Sunglass frames
Long Description: Sunglasses frames

HCPCS Code: S0580
Short Description: Polycarb lens
Long Description: Polycarbonate lens (list this code in addition to the basic code for the lens)

HCPCS Code: S0581
Short Description: Nonstnd lens
Long Description: Nonstandard lens (list this code in addition to the basic code for the lens)

HCPCS Code: S0590
Short Description: Misc integral lens serv
Long Description: Integral lens service, miscellaneous services reported separately

HCPCS Code: S0592
Short Description: Comp cont lens eval
Long Description: Comprehensive contact lens evaluation

HCPCS Code: S0595
Short Description: New lenses in pts old frame
Long Description: Dispensing new spectacle lenses for patient supplied frame

HCPCS Code: S0596
Short Description: Phakic iol refractive error
Long Description: Phakic intraocular lens for correction of refractive error

HCPCS Code: S0601
Short Description: Screening proctoscopy
Long Description: Screening proctoscopy

HCPCS Code: S0610
Short Description: Annual gynecological examina
Long Description: Annual gynecological examination, new patient

HCPCS Code: S0612
Short Description: Annual gynecological examina
Long Description: Annual gynecological examination, established patient

HCPCS Code: S0613
Short Description: Ann breast exam
Long Description: Annual gynecological examination; clinical breast examination without pelvic evaluation

HCPCS Code: S0618
Short Description: Audiometry for hearing aid
Long Description: Audiometry for hearing aid evaluation to determine the level and degree of hearing loss

HCPCS Code: S0620
Short Description: Routine ophthalmological exa
Long Description: Routine ophthalmological examination including refraction; new patient

HCPCS Code: S0621
Short Description: Routine ophthalmological exa
Long Description: Routine ophthalmological examination including refraction; established patient

HCPCS Code: S0622
Short Description: Phys exam for college
Long Description: Physical exam for college, new or established patient (list separately in addition to appropriate evaluation and management code)

HCPCS Code: S0630
Short Description: Removal of sutures
Long Description: Removal of sutures; by a physician other than the physician who originally closed the wound

HCPCS Code: S0800
Short Description: Laser in situ keratomileusis
Long Description: Laser in situ keratomileusis (lasik)

HCPCS Code: S0810
Short Description: Photorefractive keratectomy
Long Description: Photorefractive keratectomy (prk)

HCPCS Code: S0812
Short Description: Phototherap keratect
Long Description: Phototherapeutic keratectomy (ptk)