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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• 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

• 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)

• 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

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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 7/24/2026

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