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.

• S4025

  Donor services for in vitro fertilization (sperm or embryo), case rate

• S4026

  Procurement of donor sperm from sperm bank

• S4027

  Storage of previously frozen embryos

• S4028

  Microsurgical epididymal sperm aspiration (mesa)

• S4030

  Sperm procurement and cryopreservation services; initial visit

• S4031

  Sperm procurement and cryopreservation services; subsequent visit

• S4035

  Stimulated intrauterine insemination (iui), case rate

• S4037

  Cryopreserved embryo transfer, case rate

• S4040

  Monitoring and storage of cryopreserved embryos, per 30 days

• S4042

  Management of ovulation induction (interpretation of diagnostic tests and studies, non-face-to-face medical management of the patient), per cycle

• ---

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  Continued

• S4981

  Insertion of levonorgestrel-releasing intrauterine system

• S4988

  Penile contracture device, manual, greater than 3 lbs traction force

• S4989

  Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies

• S4990

  Nicotine patches, legend

• S4991

  Nicotine patches, non-legend

• S4993

  Contraceptive pills for birth control

• S4995

  Smoking cessation gum

• S5000

  Prescription drug, generic

• S5001

  Prescription drug, brand name

• S5010

  5% dextrose and 0.45% normal saline, 1000 ml

• S5011

  5% dextrose in lactated ringer's, 1000 ml

• S5012

  5% dextrose with potassium chloride, 1000 ml

• S5013

  5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1000 ml

• S5014

  5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1500 ml

• S5035

  Home infusion therapy, routine service of infusion device (e.g., pump maintenance)

• S5036

  Home infusion therapy, repair of infusion device (e.g., pump repair)

• S5100

  Day care services, adult; per 15 minutes

• S5101

  Day care services, adult; per half day

• S5102

  Day care services, adult; per diem

• S5105

  Day care services, center-based; services not included in program fee, per diem

• ---

  ---

  Continued

• S5108

  Home care training to home care client, per 15 minutes

• S5109

  Home care training to home care client, per session

• S5110

  Home care training, family; per 15 minutes

• S5111

  Home care training, family; per session

• S5115

  Home care training, non-family; per 15 minutes

• S5116

  Home care training, non-family; per session

• S5120

  Chore services; per 15 minutes

• S5121

  Chore services; per diem

• S5125

  Attendant care services; per 15 minutes

• S5126

  Attendant care services; per diem

• S5130

  Homemaker service, nos; per 15 minutes

• S5131

  Homemaker service, nos; per diem

• S5135

  Companion care, adult (e.g., iadl/adl); per 15 minutes

• S5136

  Companion care, adult (e.g., iadl/adl); per diem

• S5140

  Foster care, adult; per diem

• S5141

  Foster care, adult; per month

• S5145

  Foster care, therapeutic, child; per diem

• S5146

  Foster care, therapeutic, child; per month

• S5150

  Unskilled respite care, not hospice; per 15 minutes

• S5151

  Unskilled respite care, not hospice; per diem