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.

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  • S0012

    Butorphanol tartrate, nasal spray, 25 mg

  • S0013

    Esketamine, nasal spray, 1 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

HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/23/2026

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