HCPCS S Codes – Temporary National Codes (Non-Medicare)

• S0012 – Butorphanol tartrate, nasal spray, 25 mg
• S0014 – Tacrine hydrochloride, 10 mg
• S0021 – Injection, cefoperazone sodium, 1 gram
• S0023 – Injection, cimetidine hydrochloride, 300 mg
• S0034 – Injection, ofloxacin, 400 mg
• S0040 – Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams
• S0078 – Injection, fosphenytoin sodium, 750 mg
• S0081 – Injection, piperacillin sodium, 500 mg
• S0088 – Imatinib, 100 mg
• S0090 – Sildenafil citrate, 25 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)
• S0104 – Zidovudine, oral, 100 mg
• 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)
• S0122 – Injection, menotropins, 75 iu
• S0126 – Injection, follitropin alfa, 75 iu
• S0128 – Injection, follitropin beta, 75 iu
• S0132 – Injection, ganirelix acetate, 250 mcg
• 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
• 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
• S0169 – Calcitrol, oral, 0.25 microgram
• S0170 – Anastrozole, oral, 1 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
• S0190 – Mifepristone, oral, 200 mg
• S0191 – Misoprostol, oral, 200 mcg
• S0194 – Dialysis/stress vitamin supplement, oral, 100 capsules
• 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
• 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)
• 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
• S2065 – Simultaneous pancreas kidney transplantation
• S2066 – Breast reconstruction with gluteal artery perforator (gap) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral
• S2067 – Breast reconstruction of a single breast with "stacked" deep inferior epigastric perforator (diep) flap(s) and/or gluteal artery perforator (gap) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral
• S2068 – Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior epigastric artery (siea) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral
• S2070 – Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with endoscopic laser treatment of ureteral calculi (includes ureteral catheterization)
• S2079 – Laparoscopic esophagomyotomy (heller type)
• S2080 – Laser-assisted uvulopalatoplasty (laup)
• S2083 – Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline
• S2095 – Transcatheter occlusion or embolization for tumor destruction, percutaneous, any method, using yttrium-90 microspheres
• S2102 – Islet cell tissue transplant from pancreas; allogeneic
• S2103 – Adrenal tissue transplant to brain
• S2107 – Adoptive immunotherapy i.e. development of specific anti-tumor reactivity (e.g., tumor-infiltrating lymphocyte therapy) per course of treatment
• S2112 – Arthroscopy, knee, surgical for harvesting of cartilage (chondrocyte cells)
• S2115 – Osteotomy, periacetabular, with internal fixation
• S2117 – Arthroereisis, subtalar
• S2118 – Metal-on-metal total hip resurfacing, including acetabular and femoral components
• S2120 – Low density lipoprotein (ldl) apheresis using heparin-induced extracorporeal ldl precipitation
• S2140 – Cord blood harvesting for transplantation, allogeneic
• S2142 – Cord blood-derived stem-cell transplantation, allogeneic
• S2150 – Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre-and post-transplant care in the global definition
• S2152 – Solid organ(s), complete or segmental, single organ or combination of organs; deceased or living donor(s), procurement, transplantation, and related complications; including: drugs; supplies; hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services, and the number of days of pre- and post-transplant care in the global definition
• S2202 – Echosclerotherapy
• S2205 – Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using arterial graft(s), single coronary arterial graft
• S2206 – Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using arterial graft(s), two coronary arterial grafts
• S2207 – Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using venous graft only, single coronary venous graft
• S2208 – Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using single arterial and venous graft(s), single venous graft
• S2209 – Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using two arterial grafts and single venous graft
• S2225 – Myringotomy, laser-assisted
• S2230 – Implantation of magnetic component of semi-implantable hearing device on ossicles in middle ear
• S2235 – Implantation of auditory brain stem implant
• S2260 – Induced abortion, 17 to 24 weeks
• S2265 – Induced abortion, 25 to 28 weeks
• S2266 – Induced abortion, 29 to 31 weeks
• S2267 – Induced abortion, 32 weeks or greater
• S2300 – Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy
• S2325 – Hip core decompression
• S2340 – Chemodenervation of abductor muscle(s) of vocal cord
• S2341 – Chemodenervation of adductor muscle(s) of vocal cord
• S2342 – Nasal endoscopy for post-operative debridement following functional endoscopic sinus surgery, nasal and/or sinus cavity(s), unilateral or bilateral
• S2348 – Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, using radiofrequency energy, single or multiple levels, lumbar
• S2350 – Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, single interspace
• S2351 – Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; lumbar, each additional interspace (list separately in addition to code for primary procedure)
• S2400 – Repair, congenital diaphragmatic hernia in the fetus using temporary tracheal occlusion, procedure performed in utero
• S2401 – Repair, urinary tract obstruction in the fetus, procedure performed in utero
• S2402 – Repair, congenital cystic adenomatoid malformation in the fetus, procedure performed in utero
• S2403 – Repair, extralobar pulmonary sequestration in the fetus, procedure performed in utero
• S2404 – Repair, myelomeningocele in the fetus, procedure performed in utero
• S2405 – Repair of sacrococcygeal teratoma in the fetus, procedure performed in utero
• S2409 – Repair, congenital malformation of fetus, procedure performed in utero, not otherwise classified
• S2411 – Fetoscopic laser therapy for treatment of twin-to-twin transfusion syndrome
• S2900 – Surgical techniques requiring use of robotic surgical system (list separately in addition to code for primary procedure)
• S3000 – Diabetic indicator; retinal eye exam, dilated, bilateral
• S3005 – Performance measurement, evaluation of patient self assessment, depression
• S3600 – Stat laboratory request (situations other than s3601)
• S3601 – Emergency stat laboratory charge for patient who is homebound or residing in a nursing facility
• S3620 – Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g., galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylalanine (pku); and thyroxine, total)
• S3630 – Eosinophil count, blood, direct
• S3645 – Hiv-1 antibody testing of oral mucosal transudate
• S3650 – Saliva test, hormone level; during menopause
• S3652 – Saliva test, hormone level; to assess preterm labor risk
• S3655 – Antisperm antibodies test (immunobead)
• S3708 – Gastrointestinal fat absorption study
• S3722 – Dose optimization by area under the curve (auc) analysis, for infusional 5-fluorouracil
• S3800 – Genetic testing for amyotrophic lateral sclerosis (als)
• S3840 – Dna analysis for germline mutations of the ret proto-oncogene for susceptibility to multiple endocrine neoplasia type 2
• S3841 – Genetic testing for retinoblastoma
• S3842 – Genetic testing for von hippel-lindau disease
• S3844 – Dna analysis of the connexin 26 gene (gjb2) for susceptibility to congenital, profound deafness
• S3845 – Genetic testing for alpha-thalassemia
• S3846 – Genetic testing for hemoglobin e beta-thalassemia
• S3849 – Genetic testing for niemann-pick disease
• S3850 – Genetic testing for sickle cell anemia
• S3852 – Dna analysis for apoe epsilon 4 allele for susceptibility to alzheimer's disease
• S3853 – Genetic testing for myotonic muscular dystrophy
• S3854 – Gene expression profiling panel for use in the management of breast cancer treatment
• S3861 – Genetic testing, sodium channel, voltage-gated, type v, alpha subunit (scn5a) and variants for suspected brugada syndrome
• S3865 – Comprehensive gene sequence analysis for hypertrophic cardiomyopathy
• S3866 – Genetic analysis for a specific gene mutation for hypertrophic cardiomyopathy (hcm) in an individual with a known hcm mutation in the family
• S3870 – Comparative genomic hybridization (cgh) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability
• S3900 – Surface electromyography (emg)
• S3902 – Ballistocardiogram
• S3904 – Masters two step
• S4005 – Interim labor facility global (labor occurring but not resulting in delivery)
• S4011 – In vitro fertilization; including but not limited to identification and incubation of mature oocytes, fertilization with sperm, incubation of embryo(s), and subsequent visualization for determination of development
• S4013 – Complete cycle, gamete intrafallopian transfer (gift), case rate
• S4014 – Complete cycle, zygote intrafallopian transfer (zift), case rate
• S4015 – Complete in vitro fertilization cycle, not otherwise specified, case rate
• S4016 – Frozen in vitro fertilization cycle, case rate
• S4017 – Incomplete cycle, treatment cancelled prior to stimulation, case rate
• S4018 – Frozen embryo transfer procedure cancelled before transfer, case rate
• S4020 – In vitro fertilization procedure cancelled before aspiration, case rate
• S4021 – In vitro fertilization procedure cancelled after aspiration, case rate
• S4022 – Assisted oocyte fertilization, case rate
• S4023 – Donor egg cycle, incomplete, case rate
• S4024 – Air polymer-type a intrauterine foam, per study dose
• 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
• S4981 – Insertion of levonorgestrel-releasing intrauterine system
• 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
• 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
• 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
• S5160 – Emergency response system; installation and testing
• S5161 – Emergency response system; service fee, per month (excludes installation and testing)
• S5162 – Emergency response system; purchase only
• S5165 – Home modifications; per service
• S5170 – Home delivered meals, including preparation; per meal
• S5175 – Laundry service, external, professional; per order
• S5180 – Home health respiratory therapy, initial evaluation
• S5181 – Home health respiratory therapy, nos, per diem
• S5185 – Medication reminder service, non-face-to-face; per month
• S5190 – Wellness assessment, performed by non-physician
• S5199 – Personal care item, nos, each
• S5497 – Home infusion therapy, catheter care / maintenance, not otherwise classified; includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S5498 – Home infusion therapy, catheter care / maintenance, simple (single lumen), includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem
• S5501 – Home infusion therapy, catheter care / maintenance, complex (more than one lumen), includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S5502 – Home infusion therapy, catheter care / maintenance, implanted access device, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (use this code for interim maintenance of vascular access not currently in use)
• S5517 – Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting
• S5518 – Home infusion therapy, all supplies necessary for catheter repair
• S5520 – Home infusion therapy, all supplies (including catheter) necessary for a peripherally inserted central venous catheter (picc) line insertion
• S5521 – Home infusion therapy, all supplies (including catheter) necessary for a midline catheter insertion
• S5522 – Home infusion therapy, insertion of peripherally inserted central venous catheter (picc), nursing services only (no supplies or catheter included)
• S5523 – Home infusion therapy, insertion of midline venous catheter, nursing services only (no supplies or catheter included)
• S5550 – Insulin, rapid onset, 5 units
• S5551 – Insulin, most rapid onset (lispro or aspart); 5 units
• S5552 – Insulin, intermediate acting (nph or lente); 5 units
• S5553 – Insulin, long acting; 5 units
• S5560 – Insulin delivery device, reusable pen; 1.5 ml size
• S5561 – Insulin delivery device, reusable pen; 3 ml size
• S5565 – Insulin cartridge for use in insulin delivery device other than pump; 150 units
• S5566 – Insulin cartridge for use in insulin delivery device other than pump; 300 units
• S5570 – Insulin delivery device, disposable pen (including insulin); 1.5 ml size
• S5571 – Insulin delivery device, disposable pen (including insulin); 3 ml size
• S8030 – Scleral application of tantalum ring(s) for localization of lesions for proton beam therapy
• S8035 – Magnetic source imaging
• S8037 – Magnetic resonance cholangiopancreatography (mrcp)
• S8040 – Topographic brain mapping
• S8042 – Magnetic resonance imaging (mri), low-field
• S8055 – Ultrasound guidance for multifetal pregnancy reduction(s), technical component (only to be used when the physician doing the reduction procedure does not perform the ultrasound, guidance is included in the cpt code for multifetal pregnancy reduction - 59866)
• S8080 – Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical
• S8085 – Fluorine-18 fluorodeoxyglucose (f-18 fdg) imaging using dual-head coincidence detection system (non-dedicated pet scan)
• S8092 – Electron beam computed tomography (also known as ultrafast ct, cine ct)
• S8096 – Portable peak flow meter
• S8097 – Asthma kit (including but not limited to portable peak expiratory flow meter, instructional video, brochure, and/or spacer)
• S8100 – Holding chamber or spacer for use with an inhaler or nebulizer; without mask
• S8101 – Holding chamber or spacer for use with an inhaler or nebulizer; with mask
• S8110 – Peak expiratory flow rate (physician services)
• S8120 – Oxygen contents, gaseous, 1 unit equals 1 cubic foot
• S8121 – Oxygen contents, liquid, 1 unit equals 1 pound
• S8130 – Interferential current stimulator, 2 channel
• S8131 – Interferential current stimulator, 4 channel
• S8185 – Flutter device
• S8186 – Swivel adapter
• S8189 – Tracheostomy supply, not otherwise classified
• S8210 – Mucus trap
• S8265 – Haberman feeder for cleft lip/palate
• S8270 – Enuresis alarm, using auditory buzzer and/or vibration device
• S8301 – Infection control supplies, not otherwise specified
• S8415 – Supplies for home delivery of infant
• S8420 – Gradient pressure aid (sleeve and glove combination), custom made
• S8421 – Gradient pressure aid (sleeve and glove combination), ready made
• S8422 – Gradient pressure aid (sleeve), custom made, medium weight
• S8423 – Gradient pressure aid (sleeve), custom made, heavy weight
• S8424 – Gradient pressure aid (sleeve), ready made
• S8425 – Gradient pressure aid (glove), custom made, medium weight
• S8426 – Gradient pressure aid (glove), custom made, heavy weight
• S8427 – Gradient pressure aid (glove), ready made
• S8428 – Gradient pressure aid (gauntlet), ready made
• S8429 – Gradient pressure exterior wrap
• S8430 – Padding for compression bandage, roll
• S8431 – Compression bandage, roll
• S8450 – Splint, prefabricated, digit (specify digit by use of modifier)
• S8451 – Splint, prefabricated, wrist or ankle
• S8452 – Splint, prefabricated, elbow
• S8460 – Camisole, post-mastectomy
• S8490 – Insulin syringes (100 syringes, any size)
• S8930 – Electrical stimulation of auricular acupuncture points; each 15 minutes of personal one-on-one contact with the patient
• S8940 – Equestrian/hippotherapy, per session
• S8948 – Application of a modality (requiring constant provider attendance) to one or more areas; low-level laser; each 15 minutes
• S8950 – Complex lymphedema therapy, each 15 minutes
• S8990 – Physical or manipulative therapy performed for maintenance rather than restoration
• S8999 – Resuscitation bag (for use by patient on artificial respiration during power failure or other catastrophic event)
• S9001 – Home uterine monitor with or without associated nursing services
• S9002 – Intra-vaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device
• S9007 – Ultrafiltration monitor
• S9024 – Paranasal sinus ultrasound
• S9025 – Omnicardiogram/cardiointegram
• S9034 – Extracorporeal shockwave lithotripsy for gall stones (if performed with ercp, use 43265)
• S9055 – Procuren or other growth factor preparation to promote wound healing
• S9056 – Coma stimulation per diem
• S9061 – Home administration of aerosolized drug therapy (e.g., pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9083 – Global fee urgent care centers
• S9088 – Services provided in an urgent care center (list in addition to code for service)
• S9090 – Vertebral axial decompression, per session
• S9097 – Home visit for wound care
• S9098 – Home visit, phototherapy services (e.g., bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem
• S9110 – Telemonitoring of patient in their home, including all necessary equipment; computer system, connections, and software; maintenance; patient education and support; per month
• S9117 – Back school, per visit
• S9122 – Home health aide or certified nurse assistant, providing care in the home; per hour
• S9123 – Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)
• S9124 – Nursing care, in the home; by licensed practical nurse, per hour
• S9125 – Respite care, in the home, per diem
• S9126 – Hospice care, in the home, per diem
• S9127 – Social work visit, in the home, per diem
• S9128 – Speech therapy, in the home, per diem
• S9129 – Occupational therapy, in the home, per diem
• S9131 – Physical therapy; in the home, per diem
• S9140 – Diabetic management program, follow-up visit to non-md provider
• S9141 – Diabetic management program, follow-up visit to md provider
• S9145 – Insulin pump initiation, instruction in initial use of pump (pump not included)
• S9150 – Evaluation by ocularist
• S9152 – Speech therapy, re-evaluation
• S9208 – Home management of preterm labor, including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)
• S9209 – Home management of preterm premature rupture of membranes (pprom), including administrative services, professional pharmacy services, care coordination, and all necessary supplies or equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)
• S9211 – Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
• S9212 – Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with any home infusion per diem code)
• S9213 – Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately); per diem (do not use this code with any home infusion per diem code)
• S9214 – Home management of gestational diabetes, includes administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
• S9325 – Home infusion therapy, pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment, (drugs and nursing visits coded separately), per diem (do not use this code with s9326, s9327 or s9328)
• S9326 – Home infusion therapy, continuous (twenty-four hours or more) pain management infusion; administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9327 – Home infusion therapy, intermittent (less than twenty-four hours) pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9328 – Home infusion therapy, implanted pump pain management infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9329 – Home infusion therapy, chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with s9330 or s9331)
• S9330 – Home infusion therapy, continuous (twenty-four hours or more) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9331 – Home infusion therapy, intermittent (less than twenty-four hours) chemotherapy infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9335 – Home therapy, hemodialysis; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing services coded separately), per diem
• S9336 – Home infusion therapy, continuous anticoagulant infusion therapy (e.g., heparin), administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9338 – Home infusion therapy, immunotherapy, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9339 – Home therapy; peritoneal dialysis, administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9340 – Home therapy; enteral nutrition; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem
• S9341 – Home therapy; enteral nutrition via gravity; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem
• S9342 – Home therapy; enteral nutrition via pump; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem
• S9343 – Home therapy; enteral nutrition via bolus; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (enteral formula and nursing visits coded separately), per diem
• S9345 – Home infusion therapy, anti-hemophilic agent infusion therapy (e.g., factor viii); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9346 – Home infusion therapy, alpha-1-proteinase inhibitor (e.g., prolastin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9347 – Home infusion therapy, uninterrupted, long-term, controlled rate intravenous or subcutaneous infusion therapy (e.g., epoprostenol); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9348 – Home infusion therapy, sympathomimetic/inotropic agent infusion therapy (e.g., dobutamine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9349 – Home infusion therapy, tocolytic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9351 – Home infusion therapy, continuous or intermittent anti-emetic infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and visits coded separately), per diem
• S9353 – Home infusion therapy, continuous insulin infusion therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9355 – Home infusion therapy, chelation therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9357 – Home infusion therapy, enzyme replacement intravenous therapy; (e.g., imiglucerase); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9359 – Home infusion therapy, anti-tumor necrosis factor intravenous therapy; (e.g., infliximab); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9361 – Home infusion therapy, diuretic intravenous therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9363 – Home infusion therapy, anti-spasmotic therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9364 – Home infusion therapy, total parenteral nutrition (tpn); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem (do not use with home infusion codes s9365-s9368 using daily volume scales)
• S9365 – Home infusion therapy, total parenteral nutrition (tpn); one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem
• S9366 – Home infusion therapy, total parenteral nutrition (tpn); more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem
• S9367 – Home infusion therapy, total parenteral nutrition (tpn); more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem
• S9368 – Home infusion therapy, total parenteral nutrition (tpn); more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment including standard tpn formula (lipids, specialty amino acid formulas, drugs other than in standard formula and nursing visits coded separately), per diem
• S9370 – Home therapy, intermittent anti-emetic injection therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9372 – Home therapy; intermittent anticoagulant injection therapy (e.g., heparin); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code for flushing of infusion devices with heparin to maintain patency)
• S9373 – Home infusion therapy, hydration therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use with hydration therapy codes s9374-s9377 using daily volume scales)
• S9374 – Home infusion therapy, hydration therapy; one liter per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9375 – Home infusion therapy, hydration therapy; more than one liter but no more than two liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9376 – Home infusion therapy, hydration therapy; more than two liters but no more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9377 – Home infusion therapy, hydration therapy; more than three liters per day, administrative services, professional pharmacy services, care coordination, and all necessary supplies (drugs and nursing visits coded separately), per diem
• S9379 – Home infusion therapy, infusion therapy, not otherwise classified; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9381 – Delivery or service to high risk areas requiring escort or extra protection, per visit
• S9401 – Anticoagulation clinic, inclusive of all services except laboratory tests, per session
• S9430 – Pharmacy compounding and dispensing services
• S9432 – Medical foods for non-inborn errors of metabolism
• S9433 – Medical food nutritionally complete, administered orally, providing 100% of nutritional intake
• S9434 – Modified solid food supplements for inborn errors of metabolism
• S9435 – Medical foods for inborn errors of metabolism
• S9436 – Childbirth preparation/lamaze classes, non-physician provider, per session
• S9437 – Childbirth refresher classes, non-physician provider, per session
• S9438 – Cesarean birth classes, non-physician provider, per session
• S9439 – Vbac (vaginal birth after cesarean) classes, non-physician provider, per session
• S9441 – Asthma education, non-physician provider, per session
• S9442 – Birthing classes, non-physician provider, per session
• S9443 – Lactation classes, non-physician provider, per session
• S9444 – Parenting classes, non-physician provider, per session
• S9445 – Patient education, not otherwise classified, non-physician provider, individual, per session
• S9446 – Patient education, not otherwise classified, non-physician provider, group, per session
• S9447 – Infant safety (including cpr) classes, non-physician provider, per session
• S9449 – Weight management classes, non-physician provider, per session
• S9451 – Exercise classes, non-physician provider, per session
• S9452 – Nutrition classes, non-physician provider, per session
• S9453 – Smoking cessation classes, non-physician provider, per session
• S9454 – Stress management classes, non-physician provider, per session
• S9455 – Diabetic management program, group session
• S9460 – Diabetic management program, nurse visit
• S9465 – Diabetic management program, dietitian visit
• S9470 – Nutritional counseling, dietitian visit
• S9472 – Cardiac rehabilitation program, non-physician provider, per diem
• S9473 – Pulmonary rehabilitation program, non-physician provider, per diem
• S9474 – Enterostomal therapy by a registered nurse certified in enterostomal therapy, per diem
• S9475 – Ambulatory setting substance abuse treatment or detoxification services, per diem
• S9476 – Vestibular rehabilitation program, non-physician provider, per diem
• S9480 – Intensive outpatient psychiatric services, per diem
• S9482 – Family stabilization services, per 15 minutes
• S9484 – Crisis intervention mental health services, per hour
• S9485 – Crisis intervention mental health services, per diem
• S9490 – Home infusion therapy, corticosteroid infusion; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9494 – Home infusion therapy, antibiotic, antiviral, or antifungal therapy; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem (do not use this code with home infusion codes for hourly dosing schedules s9497-s9504)
• S9497 – Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 3 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9500 – Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 24 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9501 – Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 12 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9502 – Home infusion therapy, antibiotic, antiviral, or antifungal therapy; once every 8 hours, administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9503 – Home infusion therapy, antibiotic, antiviral, or antifungal; once every 6 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9504 – Home infusion therapy, antibiotic, antiviral, or antifungal; once every 4 hours; administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9529 – Routine venipuncture for collection of specimen(s), single home bound, nursing home, or skilled nursing facility patient
• S9537 – Home therapy; hematopoietic hormone injection therapy (e.g., erythropoietin, g-csf, gm-csf); administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9538 – Home transfusion of blood product(s); administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (blood products, drugs, and nursing visits coded separately), per diem
• S9542 – Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9558 – Home injectable therapy; growth hormone, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9559 – Home injectable therapy, interferon, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9560 – Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin), including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9562 – Home injectable therapy, palivizumab or other monoclonal antibody for rsv, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9563 – Home injectable therapy, immunotherapy, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9590 – Home therapy, irrigation therapy (e.g., sterile irrigation of an organ or anatomical cavity); including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem
• S9810 – Home therapy; professional pharmacy services for provision of infusion, specialty drug administration, and/or disease state management, not otherwise classified, per hour (do not use this code with any per diem code)
• S9900 – Services by a journal-listed christian science practitioner for the purpose of healing, per diem
• S9901 – Services by a journal-listed christian science nurse, per hour
• S9960 – Ambulance service, conventional air service, nonemergency transport, one way (fixed wing)
• S9961 – Ambulance service, conventional air service, nonemergency transport, one way (rotary wing)
• S9970 – Health club membership, annual
• S9975 – Transplant related lodging, meals and transportation, per diem
• S9976 – Lodging, per diem, not otherwise classified
• S9977 – Meals, per diem, not otherwise specified
• S9981 – Medical records copying fee, administrative
• S9982 – Medical records copying fee, per page
• S9986 – Not medically necessary service (patient is aware that service not medically necessary)
• S9988 – Services provided as part of a phase i clinical trial
• S9989 – Services provided outside of the united states of america (list in addition to code(s) for service(s))
• S9990 – Services provided as part of a phase ii clinical trial
• S9991 – Services provided as part of a phase iii clinical trial
• S9992 – Transportation costs to and from trial location and local transportation costs (e.g., fares for taxicab or bus) for clinical trial participant and one caregiver/companion
• S9994 – Lodging costs (e.g., hotel charges) for clinical trial participant and one caregiver/companion
• S9996 – Meals for clinical trial participant and one caregiver/companion
• S9999 – Sales tax

Discontinued S codes

• S0013 – Esketamine, nasal spray, 1 mgDiscontinued December 31, 2025
• S0017 – Injection, aminocaproic acid, 5 gramsDiscontinued March 31, 2025
• S0020 – Injection, bupivicaine hydrochloride, 30 mlDiscontinued June 30, 2023
• S0028 – Injection, famotidine, 20 mgDiscontinued March 31, 2025
• S0030 – Injection, metronidazole, 500 mgDiscontinued June 30, 2023
• S0032 – Injection, nafcillin sodium, 2 gramsDiscontinued March 31, 2025
• S0039 – Injection, sulfamethoxazole and trimethoprim, 10 mlDiscontinued March 31, 2025
• S0073 – Injection, aztreonam, 500 mgDiscontinued June 30, 2023
• S0074 – Injection, cefotetan disodium, 500 mgDiscontinued September 30, 2025
• S0077 – Injection, clindamycin phosphate, 300 mgDiscontinued June 30, 2023
• S0080 – Injection, pentamidine isethionate, 300 mgDiscontinued December 31, 2025
• S0144 – Injection, propofol, 10 mgDiscontinued December 31, 2014
• S0164 – Injection, pantoprazole sodium, 40 mgDiscontinued June 30, 2024
• S0166 – Injection, olanzapine, 2.5 mgDiscontinued September 30, 2023
• S0171 – Injection, bumetanide, 0.5 mgDiscontinued December 31, 2023
• S0189 – Testosterone pellet, 75 mgDiscontinued December 31, 2025
• S0195 – Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from five years to nine years of age who have not previously received the vaccineDiscontinued December 31, 2015
• S1090 – Mometasone furoate sinus implant, 370 microgramsDiscontinued September 30, 2019
• S2360 – Percutaneous vertebroplasty, one vertebral body, unilateral or bilateral injection; cervicalDiscontinued December 31, 2015
• S2361 – Each additional cervical vertebral body (list separately in addition to code for primary procedure)Discontinued December 31, 2015
• S3721 – Prostate cancer antigen 3 (pca3) testingDiscontinued December 31, 2015
• S3855 – Genetic testing for detection of mutations in the presenilin - 1 geneDiscontinued December 31, 2014
• S3890 – Dna analysis, fecal, for colorectal cancer screeningDiscontinued December 31, 2015
• S4988 – Penile contracture device, manual, greater than 3 lbs traction forceDiscontinued March 31, 2025
• S5011 – 5% dextrose in lactated ringer's, 1000 mlDiscontinued December 31, 2015
• S8032 – Low-dose computed tomography for lung cancer screeningDiscontinued September 30, 2016
• S8262 – Mandibular orthopedic repositioning device, eachDiscontinued June 30, 2015
• S9015 – Automated eeg monitoringDiscontinued December 31, 2015