HCPCS Section S: Temporary National Codes (Non-Medicare)

S0012 Butorphanol tartrate, nasal

S0013 Esketamine, nasal spray

S0014 Tacrine hydrochloride, 10 mg

S0017 Injection, aminocaproic acid

S0020 Injection, bupivicaine hydro

S0021 Injection, cefoperazone sod

S0023 Injection, cimetidine hydroc

S0028 Injection, famotidine, 20 mg

S0030 Injection, metronidazole

S0032 Injection, nafcillin sodium

S0034 Injection, ofloxacin, 400 mg

S0039 Injection, sulfamethoxazole

S0040 Injection, ticarcillin disod

S0073 Injection, aztreonam, 500 mg

S0074 Injection, cefotetan disodiu

S0077 Injection, clindamycin phosp

S0078 Injection, fosphenytoin sodi

S0080 Injection, pentamidine iseth

S0081 Injection, piperacillin sodi

S0088 Imatinib 100 mg

S0090 Sildenafil citrate, 25 mg

S0091 Granisetron 1mg

S0092 Hydromorphone 250 mg

S0093 Morphine 500 mg

S0104 Zidovudine, oral, 100 mg

S0106 Bupropion hcl sr 60 tablets

S0108 Mercaptopurine 50 mg

S0109 Methadone oral 5mg

S0117 Tretinoin topical 5 g

S0119 Ondansetron 4 mg

S0122 Inj menotropins 75 iu

S0126 Inj follitropin alfa 75 iu

S0128 Inj follitropin beta 75 iu

S0132 Inj ganirelix acetat 250 mcg

S0136 Clozapine, 25 mg

S0137 Didanosine, 25 mg

S0138 Finasteride, 5 mg

S0139 Minoxidil, 10 mg

S0140 Saquinavir, 200 mg

S0142 Colistimethate inh sol mg

S0144 Inj, propofol, 10 mg

S0145 Peg interferon alfa-2a/180

S0148 Peg interferon alfa-2b/10

S0155 Epoprostenol dilutant

S0156 Exemestane, 25 mg

S0157 Becaplermin gel 1%, 0.5 gm

S0160 Dextroamphetamine

S0164 Injection pantroprazole

S0166 Inj olanzapine 2.5mg

S0169 Calcitrol

S0170 Anastrozole 1 mg

S0171 Bumetanide 0.5 mg

S0172 Chlorambucil 2 mg

S0174 Dolasetron 50 mg

S0175 Flutamide 125 mg

S0176 Hydroxyurea 500 mg

S0177 Levamisole 50 mg

S0178 Lomustine 10 mg

S0179 Megestrol 20 mg

S0182 Procarbazine, oral

S0183 Prochlorperazine 5 mg

S0187 Tamoxifen 10 mg

S0189 Testosterone pellet 75 mg

S0190 Mifepristone, oral, 200 mg

S0191 Misoprostol, oral, 200 mcg

S0194 Vitamin suppl 100 caps

S0195 Pneumo vaccine 5-9 yrs

S0197 Prenatal vitamins 30 day

S0199 Med abortion inc all ex drug

S0201 Partial hospitalization serv

S0207 Paramedicintercep nonhospals

S0208 Paramed intrcept nonvol

S0209 Wc van mileage per mi

S0215 Nonemerg transp mileage

S0220 Medical conference by physic

S0221 Medical conference, 60 min

S0250 Comp geriatr assmt team

S0255 Hospice refer visit nonmd

S0257 End of life counseling

S0260 H&p for surgery

S0265 Genetic counsel 15 mins

S0270 Home std case rate 30 days

S0271 Home hospice case 30 days

S0272 Home episodic case 30 days

S0273 Md home visit outside cap

S0274 Nurse practr visit outs cap

S0280 Medical home, initial plan

S0281 Medical home, maintenance

S0285 Cnslt before screen colonosc

S0302 Completed epsdt

S0310 Hospitalist visit

S0311 Comp mgmt care coord adv ill

S0315 Disease management program

S0316 Follow-up/reassessment

S0317 Disease mgmt per diem

S0320 Rn telephone calls to dmp

S0340 Lifestyle mod 1st stage

S0341 Lifestyle mod 2 or 3 stage

S0342 Lifestyle mod 4th stage

S0353 Cancer treatmentplan initial

S0354 Cancer treatment plan change

S0390 Rout foot care per visit

S0395 Impression casting ft

S0400 Global eswl kidney

S0500 Dispos cont lens

S0504 Singl prscrp lens

S0506 Bifoc prscp lens

S0508 Trifoc prscrp lens

S0510 Non-prscrp lens

S0512 Daily cont lens

S0514 Color cont lens

S0515 Scleral lens liquid bandage

S0516 Safety frames

S0518 Sunglass frames

S0580 Polycarb lens

S0581 Nonstnd lens

S0590 Misc integral lens serv

S0592 Comp cont lens eval

S0595 New lenses in pts old frame

S0596 Phakic iol refractive error

S0601 Screening proctoscopy

S0610 Annual gynecological examina

S0612 Annual gynecological examina

S0613 Ann breast exam

S0618 Audiometry for hearing aid

S0620 Routine ophthalmological exa

S0621 Routine ophthalmological exa

S0622 Phys exam for college

S0630 Removal of sutures

S0800 Laser in situ keratomileusis

S0810 Photorefractive keratectomy

S0812 Phototherap keratect

S1001 Deluxe item

S1002 Custom item

S1015 Iv tubing extension set

S1016 Non-pvc intravenous administ

S1030 Gluc monitor purchase

S1031 Gluc monitor rental

S1034 Art pancreas system

S1035 Art pancreas inv disp sensor

S1036 Art pancreas ext transmitter

S1037 Art pancreas ext receiver

S1040 Cranial remolding orthosis

S1090 Mometasone sinus implant

S1091 Stent non-coronary propel

S2053 Transplantation of small int

S2054 Transplantation of multivisc

S2055 Harvesting of donor multivis

S2060 Lobar lung transplantation

S2061 Donor lobectomy (lung)

S2065 Simult panc kidn trans

S2066 Breast gap flap reconst

S2067 Breast "stacked" diep/gap

S2068 Breast diep or siea flap

S2070 Cysto laser tx ureteral calc

S2079 Lap esophagomyotomy

S2080 Laup

S2083 Adjustment gastric band

S2095 Transcath emboliz microspher

S2102 Islet cell tissue transplant

S2103 Adrenal tissue transplant

S2107 Adoptive immunotherapy

S2112 Knee arthroscp harv

S2115 Periacetabular osteotomy

S2117 Arthroereisis, subtalar

S2118 Total hip resurfacing

S2120 Low density lipoprotein(ldl)

S2140 Cord blood harvesting

S2142 Cord blood-derived stem-cell

S2150 Bmt harv/transpl 28d pkg

S2152 Solid organ transpl pkg

S2202 Echosclerotherapy

S2205 Minimally invasive direct co

S2206 Minimally invasive direct co

S2207 Minimally invasive direct co

S2208 Minimally invasive direct co

S2209 Minimally invasive direct co

S2225 Myringotomy laser-assist

S2230 Implant semi-imp hear

S2235 Implant auditory brain imp

S2260 Induced abortion 17-24 weeks

S2265 Induced abortion 25-28 wks

S2266 Induced abortion 29-31 wks

S2267 Induced abortion 32 or more

S2300 Arthroscopy, shoulder, surgi

S2325 Hip core decompression

S2340 Chemodenervation of abductor

S2341 Chemodenerv adduct vocal

S2342 Nasal endoscop po debrid

S2348 Decompress disc rf lumbar

S2350 Diskectomy, anterior, with d

S2351 Diskectomy, anterior, with d

S2360 Vertebroplast cerv 1st

S2361 Vertebroplast cerv addl

S2400 Fetal surg congen hernia

S2401 Fetal surg urin trac obstr

S2402 Fetal surg cong cyst malf

S2403 Fetal surg pulmon sequest

S2404 Fetal surg myelomeningo

S2405 Fetal surg sacrococ teratoma

S2409 Fetal surg noc

S2411 Fetoscop laser ther ttts

S2900 Robotic surgical system

S3000 Bilat dil retinal exam

S3005 Eval self-assess depression

S3600 Stat lab

S3601 Stat lab home/nf

S3620 Newborn metabolic screening

S3630 Eosinophil blood count

S3645 Hiv-1 antibody testing of or

S3650 Saliva test, hormone level;

S3652 Saliva test, hormone level;

S3655 Antisperm antibodies test

S3708 Gastrointestinal fat absorpt

S3721 Pca3 testing

S3722 Dose optimization auc - 5fu

S3800 Genetic testing als

S3840 Dna analysis ret-oncogene

S3841 Gene test retinoblastoma

S3842 Gene test hippel-lindau

S3844 Dna analysis deafness

S3845 Gene test alpha-thalassemia

S3846 Gene test beta-thalassemia

S3849 Gene test niemann-pick

S3850 Gene test sickle cell

S3852 Dna analysis apoe alzheimer

S3853 Gene test myo musclr dyst

S3854 Gene profile panel breast

S3855 Gene test presenilin-1 gene

S3861 Genetic test brugada

S3865 Comp genet test hyp cardiomy

S3866 Spec gene test hyp cardiomy

S3870 Cgh test developmental delay

S3890 Fecal dna analysis

S3900 Surface emg

S3902 Ballistocardiogram

S3904 Masters two step

S4005 Interim labor facility globa

S4011 Ivf package

S4013 Compl gift case rate

S4014 Compl zift case rate

S4015 Complete ivf nos case rate

S4016 Frozen ivf case rate

S4017 Ivf canc a stim case rate

S4018 F emb trns canc case rate

S4020 Ivf canc b4 aspir case rate

S4021 Ivf canc aftr aspr case rate

S4022 Asst oocyte fert case rate

S4023 Incompl donor egg case rate

S4024 Air polymer foam per study

S4025 Donor serv ivf case rate

S4026 Procure donor sperm

S4027 Store prev froz embryos

S4028 Microsurg epi sperm asp

S4030 Sperm procure init visit

S4031 Sperm procure subs visit

S4035 Stimulated iui case rate

S4037 Cryo embryo transf case rate

S4040 Monit store cryo embryo 30 d

S4042 Ovulation mgmt per cycle

S4981 Insert levonorgestrel ius

S4988 Penile contractur devic manu

S4989 Contracept iud

S4990 Nicotine patch legend

S4991 Nicotine patch nonlegend

S4993 Contraceptive pills for bc

S4995 Smoking cessation gum

S5000 Prescription drug, generic

S5001 Prescription drug,brand name

S5010 5% dextrose and 0.45% saline

S5011 5% dextrose in lactated ring

S5012 5% dextrose with potassium

S5013 5%dextrose/0.45%saline1000ml

S5014 D5w/0.45ns w kcl and mgs04

S5035 Hit routine device maint

S5036 Hit device repair

S5100 Adult daycare services 15min

S5101 Adult day care per half day

S5102 Adult day care per diem

S5105 Centerbased day care perdiem

S5108 Homecare train pt 15 min

S5109 Homecare train pt session

S5110 Family homecare training 15m

S5111 Family homecare train/sessio

S5115 Nonfamily homecare train/15m

S5116 Nonfamily hc train/session

S5120 Chore services per 15 min

S5121 Chore services per diem

S5125 Attendant care service /15m

S5126 Attendant care service /diem

S5130 Homaker service nos per 15m

S5131 Homemaker service nos /diem

S5135 Adult companioncare per 15m

S5136 Adult companioncare per diem

S5140 Adult foster care per diem

S5141 Adult foster care per month

S5145 Child fostercare th per diem

S5146 Ther fostercare child /month

S5150 Unskilled respite care /15m

S5151 Unskilled respitecare /diem

S5160 Emer response sys instal&tst

S5161 Emer rspns sys serv permonth

S5162 Emer rspns system purchase

S5165 Home modifications per serv

S5170 Homedelivered prepared meal

S5175 Laundry serv,ext,prof,/order

S5180 Hh respiratory thrpy in eval

S5181 Hh respiratory thrpy nos/day

S5185 Med reminder serv per month

S5190 Wellness assessment by nonph

S5199 Personal care item nos each

S5497 Hit cath care noc

S5498 Hit simple cath care

S5501 Hit complex cath care

S5502 Hit interim cath care

S5517 Hit declotting kit

S5518 Hit cath repair kit

S5520 Hit picc insert kit

S5521 Hit midline cath insert kit

S5522 Hit picc insert no supp

S5523 Hip midline cath insert kit

S5550 Insulin rapid 5 u

S5551 Insulin most rapid 5 u

S5552 Insulin intermed 5 u

S5553 Insulin long acting 5 u

S5560 Insulin reuse pen 1.5 ml

S5561 Insulin reuse pen 3 ml

S5565 Insulin cartridge 150 u

S5566 Insulin cartridge 300 u

S5570 Insulin dispos pen 1.5 ml

S5571 Insulin dispos pen 3 ml

S8030 Tantalum ring application

S8032 Low dose ct lung screening

S8035 Magnetic source imaging

S8037 Mrcp

S8040 Topographic brain mapping

S8042 Mri low field

S8055 Us guidance fetal reduct

S8080 Scintimammography

S8085 Fluorine-18 fluorodeoxygluco

S8092 Electron beam computed tomog

S8096 Portable peak flow meter

S8097 Asthma kit

S8100 Spacer without mask

S8101 Spacer with mask

S8110 Peak expiratory flow rate (p

S8120 O2 contents gas cubic ft

S8121 O2 contents liquid lb

S8130 Interferential stim 2 chan

S8131 Interferential stim 4 chan

S8185 Flutter device

S8186 Swivel adaptor

S8189 Trach supply noc

S8210 Mucus trap

S8262 Mandib ortho repos device

S8265 Haberman feeder

S8270 Enuresis alarm

S8301 Infect control supplies nos

S8415 Supplies for home delivery

S8420 Custom gradient sleev/glov

S8421 Ready gradient sleev/glov

S8422 Custom grad sleeve med

S8423 Custom grad sleeve heavy

S8424 Ready gradient sleeve

S8425 Custom grad glove med

S8426 Custom grad glove heavy

S8427 Ready gradient glove

S8428 Ready gradient gauntlet

S8429 Gradient pressure wrap

S8430 Padding for comprssn bdg

S8431 Compression bandage

S8450 Splint digit

S8451 Splint wrist or ankle

S8452 Splint elbow

S8460 Camisole post-mast

S8490 100 insulin syringes

S8930 Auricular electrostimulation

S8940 Hippotherapy per session

S8948 Low-level laser trmt 15 min

S8950 Complex lymphedema therapy,

S8990 Pt or manip for maint

S8999 Resuscitation bag

S9001 Home uterine monitor with or

S9002 Intra-vag motion sens biofk

S9007 Ultrafiltration monitor

S9015 Automated eeg monitoring

S9024 Paranasal sinus ultrasound

S9025 Omnicardiogram/cardiointegra

S9034 Eswl for gallstones

S9055 Procuren or other growth fac

S9056 Coma stimulation per diem

S9061 Medical supplies and equipme

S9083 Urgent care center global

S9088 Services provided in urgent

S9090 Vertebral axial decompressio

S9097 Home visit wound care

S9098 Home phototherapy visit

S9110 Telemonitoring/home per mnth

S9117 Back school visit

S9122 Home health aide or certifie

S9123 Nursing care in home rn

S9124 Nursing care, in the home; b

S9125 Respite care, in the home, p

S9126 Hospice care, in the home, p

S9127 Social work visit, in the ho

S9128 Speech therapy, in the home,

S9129 Occupational therapy, in the

S9131 Pt in the home per diem

S9140 Diabetic management program,

S9141 Diabetic management program,

S9145 Insulin pump initiation

S9150 Evaluation by ocularist

S9152 Speech therapy, re-eval

S9208 Home mgmt preterm labor

S9209 Home mgmt pprom

S9211 Home mgmt gest hypertension

S9212 Hm postpar hyper per diem

S9213 Hm preeclamp per diem

S9214 Hm gest dm per diem

S9325 Hit pain mgmt per diem

S9326 Hit cont pain per diem

S9327 Hit int pain per diem

S9328 Hit pain imp pump diem

S9329 Hit chemo per diem

S9330 Hit cont chem diem

S9331 Hit intermit chemo diem

S9335 Ht hemodialysis diem

S9336 Hit cont anticoag diem

S9338 Hit immunotherapy diem

S9339 Hit periton dialysis diem

S9340 Hit enteral per diem

S9341 Hit enteral grav diem

S9342 Hit enteral pump diem

S9343 Hit enteral bolus nurs

S9345 Hit anti-hemophil diem

S9346 Hit alpha-1-proteinas diem

S9347 Hit longterm infusion diem

S9348 Hit sympathomim diem

S9349 Hit tocolysis diem

S9351 Hit cont antiemetic diem

S9353 Hit cont insulin diem

S9355 Hit chelation diem

S9357 Hit enzyme replace diem

S9359 Hit anti-tnf per diem

S9361 Hit diuretic infus diem

S9363 Hit anti-spasmotic diem

S9364 Hit tpn total diem

S9365 Hit tpn 1 liter diem

S9366 Hit tpn 2 liter diem

S9367 Hit tpn 3 liter diem

S9368 Hit tpn over 3l diem

S9370 Ht inj antiemetic diem

S9372 Ht inj anticoag diem

S9373 Hit hydra total diem

S9374 Hit hydra 1 liter diem

S9375 Hit hydra 2 liter diem

S9376 Hit hydra 3 liter diem

S9377 Hit hydra over 3l diem

S9379 Hit noc per diem

S9381 Hit high risk/escort

S9401 Anticoag clinic per session

S9430 Pharmacy comp/disp serv

S9432 Med food non inborn err meta

S9433 Medical food oral 100% nutr

S9434 Mod solid food suppl

S9435 Medical foods for inborn err

S9436 Lamaze class

S9437 Childbirth refresher class

S9438 Cesarean birth class

S9439 Vbac class

S9441 Asthma education

S9442 Birthing class

S9443 Lactation class

S9444 Parenting class

S9445 Pt education noc individ

S9446 Pt education noc group

S9447 Infant safety class

S9449 Weight mgmt class

S9451 Exercise class

S9452 Nutrition class

S9453 Smoking cessation class

S9454 Stress mgmt class

S9455 Diabetic management program,

S9460 Diabetic management program,

S9465 Diabetic management program,

S9470 Nutritional counseling, diet

S9472 Cardiac rehabilitation progr

S9473 Pulmonary rehabilitation pro

S9474 Enterostomal therapy by a re

S9475 Ambulatory setting substance

S9476 Vestibular rehab per diem

S9480 Intensive outpatient psychia

S9482 Family stabilization 15 min

S9484 Crisis intervention per hour

S9485 Crisis intervention mental h

S9490 Hit corticosteroid/diem

S9494 Hit antibiotic total diem

S9497 Hit antibiotic q3h diem

S9500 Hit antibiotic q24h diem

S9501 Hit antibiotic q12h diem

S9502 Hit antibiotic q8h diem

S9503 Hit antibiotic q6h diem

S9504 Hit antibiotic q4h diem

S9529 Venipuncture home/snf

S9537 Ht hem horm inj diem

S9538 Hit blood products diem

S9542 Ht inj noc per diem

S9558 Ht inj growth horm diem

S9559 Hit inj interferon diem

S9560 Ht inj hormone diem

S9562 Ht inj palivizumab/ab diem

S9563 Ht inj immuno diem

S9590 Ht irrigation diem

S9810 Ht pharm per hour

S9900 Christian sci pract visit

S9901 Christian sci nurse visit

S9960 Air ambulanc nonemerg fixed

S9961 Air ambulan nonemerg rotary

S9970 Health club membership yr

S9975 Transplant related per diem

S9976 Lodging per diem

S9977 Meals per diem

S9981 Med record copy admin

S9982 Med record copy per page

S9986 Not medically necessary svc

S9988 Serv part of phase i trial

S9989 Services outside us

S9990 Services provided as part of

S9991 Services provided as part of

S9992 Transportation costs to and

S9994 Lodging costs (e.g. hotel ch

S9996 Meals for clinical trial par

S9999 Sales tax

Section S: Temporary National Codes (Non-Medicare)

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