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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• S0354

  Treatment planning and care coordination management for cancer, established patient with a change of regimen

• S0390

  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

• S0395

  Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic

• S0400

  Global fee for extracorporeal shock wave lithotripsy treatment of kidney stone(s)

• S0500

  Disposable contact lens, per lens

• S0504

  Single vision prescription lens (safety, athletic, or sunglass), per lens

• S0506

  Bifocal vision prescription lens (safety, athletic, or sunglass), per lens

• S0508

  Trifocal vision prescription lens (safety, athletic, or sunglass), per lens

• S0510

  Non-prescription lens (safety, athletic, or sunglass), per lens

• S0512

  Daily wear specialty contact lens, per lens

• S0514

  Color contact lens, per lens

• S0515

  Scleral lens, liquid bandage device, per lens

• S0516

  Safety eyeglass frames

• S0518

  Sunglasses frames

• S0580

  Polycarbonate lens (list this code in addition to the basic code for the lens)

• S0581

  Nonstandard lens (list this code in addition to the basic code for the lens)

• S0590

  Integral lens service, miscellaneous services reported separately

• S0592

  Comprehensive contact lens evaluation

• S0595

  Dispensing new spectacle lenses for patient supplied frame

• S0596

  Phakic intraocular lens for correction of refractive error

• S0601

  Screening proctoscopy

• S0610

  Annual gynecological examination, new patient

• S0612

  Annual gynecological examination, established patient

• S0613

  Annual gynecological examination; clinical breast examination without pelvic evaluation

• S0618

  Audiometry for hearing aid evaluation to determine the level and degree of hearing loss

• S0620

  Routine ophthalmological examination including refraction; new patient

• S0621

  Routine ophthalmological examination including refraction; established patient

• S0622

  Physical exam for college, new or established patient (list separately in addition to appropriate evaluation and management code)

• S0630

  Removal of sutures; by a physician other than the physician who originally closed the wound

• S0800

  Laser in situ keratomileusis (lasik)

• S0810

  Photorefractive keratectomy (prk)

• S0812

  Phototherapeutic keratectomy (ptk)

• S1001

  Deluxe item, patient aware (list in addition to code for basic item)

• S1002

  Customized item (list in addition to code for basic item)

• S1015

  Iv tubing extension set

• S1016

  Non-pvc (polyvinyl chloride) intravenous administration set, for use with drugs that are not stable in pvc e.g., paclitaxel

• S1030

  Continuous noninvasive glucose monitoring device, purchase (for physician interpretation of data, use cpt code)

• S1031

  Continuous noninvasive glucose monitoring device, rental, including sensor, sensor replacement, and download to monitor (for physician interpretation of data, use cpt code)

• S1034

  Artificial pancreas device system (e.g., low glucose suspend (lgs) feature) including continuous glucose monitor, blood glucose device, insulin pump and computer algorithm that communicates with all of the devices

• S1035

  Sensor; invasive (e.g., subcutaneous), disposable, for use with artificial pancreas device system

• S1036

  Transmitter; external, for use with artificial pancreas device system

• S1037

  Receiver (monitor); external, for use with artificial pancreas device system

• S1040

  Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s)

• S1090

  Mometasone furoate sinus implant, 370 micrograms

• S1091

  Stent, non-coronary, temporary, with delivery system (propel)

• S2053

  Transplantation of small intestine and liver allografts

• S2054

  Transplantation of multivisceral organs

• S2055

  Harvesting of donor multivisceral organs, with preparation and maintenance of allografts; from cadaver donor

• S2060

  Lobar lung transplantation

• S2061

  Donor lobectomy (lung) for transplantation, living donor

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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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