Blue Cross/Blue Shield and other commercial payers develop S codes to report drugs, services, and supplies. These codes may not be used to bill services paid under any Medicare payment system. Medicare does not reimburse for services under S codes.


  • S0012

    Butorphanol tartrate, nasal spray, 25 mg
  • S0014

    Tacrine hydrochloride, 10 mg
  • S0017

    Injection, aminocaproic acid, 5 grams
  • S0020

    Injection, bupivicaine hydrochloride, 30 ml
  • S0021

    Injection, cefoperazone sodium, 1 gram
  • S0023

    Injection, cimetidine hydrochloride, 300 mg
  • S0028

    Injection, famotidine, 20 mg
  • S0030

    Injection, metronidazole, 500 mg
  • S0032

    Injection, nafcillin sodium, 2 grams
  • S0034

    Injection, ofloxacin, 400 mg
  • S0039

    Injection, sulfamethoxazole and trimethoprim, 10 ml
  • S0040

    Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams
  • S0073

    Injection, aztreonam, 500 mg
  • S0074

    Injection, cefotetan disodium, 500 mg
  • S0077

    Injection, clindamycin phosphate, 300 mg
  • S0078

    Injection, fosphenytoin sodium, 750 mg
  • S0080

    Injection, pentamidine isethionate, 300 mg
  • S0081

    Injection, piperacillin sodium, 500 mg
  • S0088

    Imatinib, 100 mg
  • S0090

    Sildenafil citrate, 25 mg
  • S0091

    Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166)
  • S0092

    Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump)
  • S0093

    Injection, morphine sulfate, 500 mg (loading dose for infusion pump)
  • S0104

    Zidovudine, oral, 100 mg
  • S0106

    Bupropion hcl sustained release tablet, 150 mg, per bottle of 60 tablets
  • S0108

    Mercaptopurine, oral, 50 mg
  • S0109

    Methadone, oral, 5 mg
  • S0117

    Tretinoin, topical, 5 grams
  • S0119

    Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code)
  • S0122

    Injection, menotropins, 75 iu
  • S0126

    Injection, follitropin alfa, 75 iu
  • S0128

    Injection, follitropin beta, 75 iu
  • S0132

    Injection, ganirelix acetate, 250 mcg
  • S0136

    Clozapine, 25 mg
  • S0137

    Didanosine (ddi), 25 mg
  • S0138

    Finasteride, 5 mg
  • S0139

    Minoxidil, 10 mg
  • S0140

    Saquinavir, 200 mg
  • S0142

    Colistimethate sodium, inhalation solution administered through dme, concentrated form, per mg
  • S0144

    Injection, propofol, 10 mg
  • S0145

    Injection, pegylated interferon alfa-2a, 180 mcg per ml
  • S0148

    Injection, pegylated interferon alfa-2b, 10 mcg
  • S0155

    Sterile dilutant for epoprostenol, 50 ml
  • S0156

    Exemestane, 25 mg
  • S0157

    Becaplermin gel 0.01%, 0.5 gm
  • S0160

    Dextroamphetamine sulfate, 5 mg
  • S0164

    Injection, pantoprazole sodium, 40 mg
  • S0166

    Injection, olanzapine, 2.5 mg
  • S0169

    Calcitrol, 0.25 microgram
  • S0170

    Anastrozole, oral, 1 mg