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HCPCS Procedure & Supply Codes

Private Payer Codes

section notes

Drugs Administered

section notes
S0012‑S0013   Nasal spray
S0014   Tacrine hydrochloride, 10 mg
S0017‑S0164   Injections
S0088   Imatinib, 100 mg
S0090   Sildenafil citrate, 25 mg
S0091   Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare st...
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, u...
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, concentrate...
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, 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 st...
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 medica...
S0187   Tamoxifen citrate, oral, 10 mg
S0189   Testosterone pellet, 75 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
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