HCPCS S-Codes
Commercial Payers (Temporary Codes)

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.

  • S0170

    Anastrozole, oral, 1 mg

  • S0171

    Injection, bumetanide, 0.5 mg

  • S0172

    Chlorambucil, oral, 2 mg

  • S0174

    Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)

  • S0175

    Flutamide, oral, 125 mg

  • S0176

    Hydroxyurea, oral, 500 mg

  • S0177

    Levamisole hydrochloride, oral, 50 mg

  • S0178

    Lomustine, oral, 10 mg

  • S0179

    Megestrol acetate, oral, 20 mg

  • S0182

    Procarbazine hydrochloride, oral, 50 mg
  • Continued

  • S0183

    Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164)

  • S0187

    Tamoxifen citrate, oral, 10 mg

  • S0189

    Testosterone pellet, 75 mg

  • S0190

    Mifepristone, oral, 200 mg

  • S0191

    Misoprostol, oral, 200 mcg

  • S0194

    Dialysis/stress vitamin supplement, oral, 100 capsules

  • S0195

    Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from five years to nine years of age who have not previously received the vaccine

  • S0197

    Prenatal vitamins, 30-day supply

  • S0199

    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

  • S0201

    Partial hospitalization services, less than 24 hours, per diem

  • S0207

    Paramedic intercept, non-hospital-based als service (non-voluntary), non-transport

  • S0208

    Paramedic intercept, hospital-based als service (non-voluntary), non-transport

  • S0209

    Wheelchair van, mileage, per mile

  • S0215

    Non-emergency transportation; mileage, per mile

  • S0220

    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

  • S0221

    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

  • S0250

    Comprehensive geriatric assessment and treatment planning performed by assessment team

  • S0255

    Hospice referral visit (advising patient and family of care options) performed by nurse, social worker, or other designated staff

  • S0257

    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)

  • S0260

    History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service)
  • Continued

  • S0265

    Genetic counseling, under physician supervision, each 15 minutes

  • S0270

    Physician management of patient home care, standard monthly case rate (per 30 days)

  • S0271

    Physician management of patient home care, hospice monthly case rate (per 30 days)

  • S0272

    Physician management of patient home care, episodic care monthly case rate (per 30 days)

  • S0273

    Physician visit at member's home, outside of a capitation arrangement

  • S0274

    Nurse practitioner visit at member's home, outside of a capitation arrangement

  • S0280

    Medical home program, comprehensive care coordination and planning, initial plan

  • S0281

    Medical home program, comprehensive care coordination and planning, maintenance of plan

  • S0285

    Colonoscopy consultation performed prior to a screening colonoscopy procedure

  • S0302

    Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)

  • S0310

    Hospitalist services (list separately in addition to code for appropriate evaluation and management service)

  • S0311

    Comprehensive management and care coordination for advanced illness, per calendar month

  • S0315

    Disease management program; initial assessment and initiation of the program

  • S0316

    Disease management program, follow-up/reassessment

  • S0317

    Disease management program; per diem

  • S0320

    Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month

  • S0340

    Lifestyle modification program for management of coronary artery disease, including all supportive services; first quarter / stage

  • S0341

    Lifestyle modification program for management of coronary artery disease, including all supportive services; second or third quarter / stage

  • S0342

    Lifestyle modification program for management of coronary artery disease, including all supportive services; fourth quarter / stage

  • S0353

    Treatment planning and care coordination management for cancer, initial treatment