HCPCS Service Codes - Other medical items or services

HCPCS Codes for Other medical items or services

• Q9969

  Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose

• Q9973

  Injection, epoetin beta, 1 microgram, (non-esrd use)

• Q9984

  Levonorgestrel-releasing intrauterine contraceptive system (kyleena), 19.5 mg

• Q9988

  Platelets, pheresis, pathogen-reduced, each unit

• S0088

  Imatinib, 100 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)

• 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)

• 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

• 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

• 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

• 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

• 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