Section S: Private Payer Codes

505 procedure codes. CMS quarterly release — October 2026.

HCPCS Level II codes are updated quarterly by CMS. This listing reflects the October 2026 quarterly release.
Code Description Pricing
S0012 Butorphanol tartrate, nasal 00
S0014 Tacrine hydrochloride, 10 mg 00
S0021 Injection, cefoperazone sod 00
S0023 Injection, cimetidine hydroc 00
S0034 Injection, ofloxacin, 400 mg 00
S0040 Injection, ticarcillin disod 00
S0078 Injection, fosphenytoin sodi 00
S0081 Injection, piperacillin sodi 00
S0088 Imatinib 100 mg 00
S0090 Sildenafil citrate, 25 mg 00
S0091 Granisetron 1mg 00
S0092 Hydromorphone 250 mg 00
S0093 Morphine 500 mg 00
S0104 Zidovudine, oral, 100 mg 00
S0106 Bupropion hcl sr 60 tablets 00
S0108 Mercaptopurine 50 mg 00
S0109 Methadone oral 5mg 00
S0117 Tretinoin topical 5 g 00
S0119 Ondansetron 4 mg 00
S0122 Inj menotropins 75 iu 00
S0126 Inj follitropin alfa 75 iu 00
S0128 Inj follitropin beta 75 iu 00
S0132 Inj ganirelix acetat 250 mcg 00
S0136 Clozapine, 25 mg 00
S0137 Didanosine, 25 mg 00
S0138 Finasteride, 5 mg 00
S0139 Minoxidil, 10 mg 00
S0140 Saquinavir, 200 mg 00
S0142 Colistimethate inh sol mg 00
S0145 Peg interferon alfa-2a/180 00
S0148 Peg interferon alfa-2b/10 00
S0155 Epoprostenol dilutant 00
S0156 Exemestane, 25 mg 00
S0157 Becaplermin gel 1%, 0.5 gm 00
S0160 Dextroamphetamine 00
S0169 Calcitrol 00
S0170 Anastrozole 1 mg 00
S0172 Chlorambucil 2 mg 00
S0174 Dolasetron 50 mg 00
S0175 Flutamide 125 mg 00
S0176 Hydroxyurea 500 mg 00
S0177 Levamisole 50 mg 00
S0178 Lomustine 10 mg 00
S0179 Megestrol 20 mg 00
S0182 Procarbazine, oral 00
S0183 Prochlorperazine 5 mg 00
S0187 Tamoxifen 10 mg 00
S0190 Mifepristone, oral, 200 mg 00
S0191 Misoprostol, oral, 200 mcg 00
S0194 Vitamin suppl 100 caps 00
S0197 Prenatal vitamins 30 day 00
S0199 Med abortion inc all ex drug 00
S0201 Partial hospitalization serv 00
S0207 Paramedicintercep nonhospals 00
S0208 Paramed intrcept nonvol 00
S0209 Wc van mileage per mi 00
S0215 Nonemerg transp mileage 00
S0220 Medical conference by physic 00
S0221 Medical conference, 60 min 00
S0250 Comp geriatr assmt team 00
S0255 Hospice refer visit nonmd 00
S0257 End of life counseling 00
S0260 H&p for surgery 00
S0265 Genetic counsel 15 mins 00
S0270 Home std case rate 30 days 00
S0271 Home hospice case 30 days 00
S0272 Home episodic case 30 days 00
S0273 Md home visit outside cap 00
S0274 Nurse practr visit outs cap 00
S0280 Medical home, initial plan 00
S0281 Medical home, maintenance 00
S0285 Cnslt before screen colonosc 00
S0302 Completed epsdt 00
S0310 Hospitalist visit 00
S0311 Comp mgmt care coord adv ill 00
S0315 Disease management program 00
S0316 Follow-up/reassessment 00
S0317 Disease mgmt per diem 00
S0320 Rn telephone calls to dmp 00
S0340 Lifestyle mod 1st stage 00
S0341 Lifestyle mod 2 or 3 stage 00
S0342 Lifestyle mod 4th stage 00
S0353 Cancer treatmentplan initial 00
S0354 Cancer treatment plan change 00
S0390 Rout foot care per visit 00
S0395 Impression casting ft 00
S0400 Global eswl kidney 00
S0500 Dispos cont lens 00
S0504 Singl prscrp lens 00
S0506 Bifoc prscp lens 00
S0508 Trifoc prscrp lens 00
S0510 Non-prscrp lens 00
S0512 Daily cont lens 00
S0514 Color cont lens 00
S0515 Scleral lens liquid bandage 00
S0516 Safety frames 00
S0518 Sunglass frames 00
S0580 Polycarb lens 00
S0581 Nonstnd lens 00
S0590 Misc integral lens serv 00
S0592 Comp cont lens eval 00
S0595 New lenses in pts old frame 00
S0596 Phakic iol refractive error 00
S0601 Screening proctoscopy 00
S0610 Annual gynecological examina 00
S0612 Annual gynecological examina 00
S0613 Ann breast exam 00
S0618 Audiometry for hearing aid 00
S0620 Routine ophthalmological exa 00
S0621 Routine ophthalmological exa 00
S0622 Phys exam for college 00
S0630 Removal of sutures 00
S0800 Laser in situ keratomileusis 00
S0810 Photorefractive keratectomy 00
S0812 Phototherap keratect 00
S1001 Deluxe item 00
S1002 Custom item 00
S1015 Iv tubing extension set 00
S1016 Non-pvc intravenous administ 00
S1030 Gluc monitor purchase 00
S1031 Gluc monitor rental 00
S1034 Art pancreas system 00
S1035 Art pancreas inv disp sensor 00
S1036 Art pancreas ext transmitter 00
S1037 Art pancreas ext receiver 00
S1040 Cranial remolding orthosis 00
S1091 Stent non-coronary propel 00
S2053 Transplantation of small int 00
S2054 Transplantation of multivisc 00
S2055 Harvesting of donor multivis 00
S2060 Lobar lung transplantation 00
S2061 Donor lobectomy (lung) 00
S2065 Simult panc kidn trans 00
S2066 Breast gap flap reconst 00
S2067 Breast "stacked" diep/gap 00
S2068 Breast diep or siea flap 00
S2070 Cysto laser tx ureteral calc 00
S2079 Lap esophagomyotomy 00
S2080 Laup 00
S2083 Adjustment gastric band 00
S2095 Transcath emboliz microspher 00
S2102 Islet cell tissue transplant 00
S2103 Adrenal tissue transplant 00
S2107 Adoptive immunotherapy 00
S2112 Knee arthroscp harv 00
S2115 Periacetabular osteotomy 00
S2117 Arthroereisis, subtalar 00
S2118 Total hip resurfacing 00
S2120 Low density lipoprotein(ldl) 00
S2140 Cord blood harvesting 00
S2142 Cord blood-derived stem-cell 00
S2150 Bmt harv/transpl 28d pkg 00
S2152 Solid organ transpl pkg 00
S2202 Echosclerotherapy 00
S2205 Minimally invasive direct co 00
S2206 Minimally invasive direct co 00
S2207 Minimally invasive direct co 00
S2208 Minimally invasive direct co 00
S2209 Minimally invasive direct co 00
S2225 Myringotomy laser-assist 00
S2230 Implant semi-imp hear 00
S2235 Implant auditory brain imp 00
S2260 Induced abortion 17-24 weeks 00
S2265 Induced abortion 25-28 wks 00
S2266 Induced abortion 29-31 wks 00
S2267 Induced abortion 32 or more 00
S2300 Arthroscopy, shoulder, surgi 00
S2325 Hip core decompression 00
S2340 Chemodenervation of abductor 00
S2341 Chemodenerv adduct vocal 00
S2342 Nasal endoscop po debrid 00
S2348 Decompress disc rf lumbar 00
S2350 Diskectomy, anterior, with d 00
S2351 Diskectomy, anterior, with d 00
S2400 Fetal surg congen hernia 00
S2401 Fetal surg urin trac obstr 00
S2402 Fetal surg cong cyst malf 00
S2403 Fetal surg pulmon sequest 00
S2404 Fetal surg myelomeningo 00
S2405 Fetal surg sacrococ teratoma 00
S2409 Fetal surg noc 00
S2411 Fetoscop laser ther ttts 00
S2900 Robotic surgical system 00
S3000 Bilat dil retinal exam 00
S3005 Eval self-assess depression 00
S3600 Stat lab 00
S3601 Stat lab home/nf 00
S3620 Newborn metabolic screening 00
S3630 Eosinophil blood count 00
S3645 Hiv-1 antibody testing of or 00
S3650 Saliva test, hormone level; 00
S3652 Saliva test, hormone level; 00
S3655 Antisperm antibodies test 00
S3708 Gastrointestinal fat absorpt 00
S3722 Dose optimization auc - 5fu 00
S3800 Genetic testing als 00
S3840 Dna analysis ret-oncogene 00
S3841 Gene test retinoblastoma 00
S3842 Gene test hippel-lindau 00
S3844 Dna analysis deafness 00
S3845 Gene test alpha-thalassemia 00
S3846 Gene test beta-thalassemia 00
S3849 Gene test niemann-pick 00
S3850 Gene test sickle cell 00
S3852 Dna analysis apoe alzheimer 00
S3853 Gene test myo musclr dyst 00
S3854 Gene profile panel breast 00
S3861 Genetic test brugada 00
S3865 Comp genet test hyp cardiomy 00
S3866 Spec gene test hyp cardiomy 00
S3870 Cgh test developmental delay 00
S3900 Surface emg 00
S3902 Ballistocardiogram 00
S3904 Masters two step 00
S4005 Interim labor facility globa 00
S4011 Ivf package 00
S4013 Compl gift case rate 00
S4014 Compl zift case rate 00
S4015 Complete ivf nos case rate 00
S4016 Frozen ivf case rate 00
S4017 Ivf canc a stim case rate 00
S4018 F emb trns canc case rate 00
S4020 Ivf canc b4 aspir case rate 00
S4021 Ivf canc aftr aspr case rate 00
S4022 Asst oocyte fert case rate 00
S4023 Incompl donor egg case rate 00
S4024 Air polymer foam per study 00
S4025 Donor serv ivf case rate 00
S4026 Procure donor sperm 00
S4027 Store prev froz embryos 00
S4028 Microsurg epi sperm asp 00
S4030 Sperm procure init visit 00
S4031 Sperm procure subs visit 00
S4035 Stimulated iui case rate 00
S4037 Cryo embryo transf case rate 00
S4040 Monit store cryo embryo 30 d 00
S4042 Ovulation mgmt per cycle 00
S4981 Insert levonorgestrel ius 00
S4989 Contracept iud 00
S4990 Nicotine patch legend 00
S4991 Nicotine patch nonlegend 00
S4993 Contraceptive pills for bc 00
S4995 Smoking cessation gum 00
S5000 Prescription drug, generic 00
S5001 Prescription drug,brand name 00
S5010 5% dextrose and 0.45% saline 00
S5012 5% dextrose with potassium 00
S5013 5%dextrose/0.45%saline1000ml 00
S5014 D5w/0.45ns w kcl and mgs04 00
S5035 Hit routine device maint 00
S5036 Hit device repair 00
S5100 Adult daycare services 15min 00
S5101 Adult day care per half day 00
S5102 Adult day care per diem 00
S5105 Centerbased day care perdiem 00
S5108 Homecare train pt 15 min 00
S5109 Homecare train pt session 00
S5110 Family homecare training 15m 00
S5111 Family homecare train/sessio 00
S5115 Nonfamily homecare train/15m 00
S5116 Nonfamily hc train/session 00
S5120 Chore services per 15 min 00
S5121 Chore services per diem 00
S5125 Attendant care service /15m 00
S5126 Attendant care service /diem 00
S5130 Homaker service nos per 15m 00
S5131 Homemaker service nos /diem 00
S5135 Adult companioncare per 15m 00
S5136 Adult companioncare per diem 00
S5140 Adult foster care per diem 00
S5141 Adult foster care per month 00
S5145 Child fostercare th per diem 00
S5146 Ther fostercare child /month 00
S5150 Unskilled respite care /15m 00
S5151 Unskilled respitecare /diem 00
S5160 Emer response sys instal&tst 00
S5161 Emer rspns sys serv permonth 00
S5162 Emer rspns system purchase 00
S5165 Home modifications per serv 00
S5170 Homedelivered prepared meal 00
S5175 Laundry serv,ext,prof,/order 00
S5180 Hh respiratory thrpy in eval 00
S5181 Hh respiratory thrpy nos/day 00
S5185 Med reminder serv per month 00
S5190 Wellness assessment by nonph 00
S5199 Personal care item nos each 00
S5497 Hit cath care noc 00
S5498 Hit simple cath care 00
S5501 Hit complex cath care 00
S5502 Hit interim cath care 00
S5517 Hit declotting kit 00
S5518 Hit cath repair kit 00
S5520 Hit picc insert kit 00
S5521 Hit midline cath insert kit 00
S5522 Hit picc insert no supp 00
S5523 Hip midline cath insert kit 00
S5550 Insulin rapid 5 u 00
S5551 Insulin most rapid 5 u 00
S5552 Insulin intermed 5 u 00
S5553 Insulin long acting 5 u 00
S5560 Insulin reuse pen 1.5 ml 00
S5561 Insulin reuse pen 3 ml 00
S5565 Insulin cartridge 150 u 00
S5566 Insulin cartridge 300 u 00
S5570 Insulin dispos pen 1.5 ml 00
S5571 Insulin dispos pen 3 ml 00
S8030 Tantalum ring application 00
S8035 Magnetic source imaging 00
S8037 Mrcp 00
S8040 Topographic brain mapping 00
S8042 Mri low field 00
S8055 Us guidance fetal reduct 00
S8080 Scintimammography 00
S8085 Fluorine-18 fluorodeoxygluco 00
S8092 Electron beam computed tomog 00
S8096 Portable peak flow meter 00
S8097 Asthma kit 00
S8100 Spacer without mask 00
S8101 Spacer with mask 00
S8110 Peak expiratory flow rate (p 00
S8120 O2 contents gas cubic ft 00
S8121 O2 contents liquid lb 00
S8130 Interferential stim 2 chan 00
S8131 Interferential stim 4 chan 00
S8185 Flutter device 00
S8186 Swivel adaptor 00
S8189 Trach supply noc 00
S8210 Mucus trap 00
S8265 Haberman feeder 00
S8270 Enuresis alarm 00
S8301 Infect control supplies nos 00
S8415 Supplies for home delivery 00
S8420 Custom gradient sleev/glov 00
S8421 Ready gradient sleev/glov 00
S8422 Custom grad sleeve med 00
S8423 Custom grad sleeve heavy 00
S8424 Ready gradient sleeve 00
S8425 Custom grad glove med 00
S8426 Custom grad glove heavy 00
S8427 Ready gradient glove 00
S8428 Ready gradient gauntlet 00
S8429 Gradient pressure wrap 00
S8430 Padding for comprssn bdg 00
S8431 Compression bandage 00
S8450 Splint digit 00
S8451 Splint wrist or ankle 00
S8452 Splint elbow 00
S8460 Camisole post-mast 00
S8490 100 insulin syringes 00
S8930 Auricular electrostimulation 00
S8940 Hippotherapy per session 00
S8948 Low-level laser trmt 15 min 00
S8950 Complex lymphedema therapy, 00
S8990 Pt or manip for maint 00
S8999 Resuscitation bag 00
S9001 Home uterine monitor with or 00
S9002 Intra-vag motion sens biofk 00
S9007 Ultrafiltration monitor 00
S9024 Paranasal sinus ultrasound 00
S9025 Omnicardiogram/cardiointegra 00
S9034 Eswl for gallstones 00
S9055 Procuren or other growth fac 00
S9056 Coma stimulation per diem 00
S9061 Medical supplies and equipme 00
S9083 Urgent care center global 00
S9088 Services provided in urgent 00
S9090 Vertebral axial decompressio 00
S9097 Home visit wound care 00
S9098 Home phototherapy visit 00
S9110 Telemonitoring/home per mnth 00
S9117 Back school visit 00
S9122 Home health aide or certifie 00
S9123 Nursing care in home rn 00
S9124 Nursing care, in the home; b 00
S9125 Respite care, in the home, p 00
S9126 Hospice care, in the home, p 00
S9127 Social work visit, in the ho 00
S9128 Speech therapy, in the home, 00
S9129 Occupational therapy, in the 00
S9131 Pt in the home per diem 00
S9140 Diabetic management program, 00
S9141 Diabetic management program, 00
S9145 Insulin pump initiation 00
S9150 Evaluation by ocularist 00
S9152 Speech therapy, re-eval 00
S9208 Home mgmt preterm labor 00
S9209 Home mgmt pprom 00
S9211 Home mgmt gest hypertension 00
S9212 Hm postpar hyper per diem 00
S9213 Hm preeclamp per diem 00
S9214 Hm gest dm per diem 00
S9325 Hit pain mgmt per diem 00
S9326 Hit cont pain per diem 00
S9327 Hit int pain per diem 00
S9328 Hit pain imp pump diem 00
S9329 Hit chemo per diem 00
S9330 Hit cont chem diem 00
S9331 Hit intermit chemo diem 00
S9335 Ht hemodialysis diem 00
S9336 Hit cont anticoag diem 00
S9338 Hit immunotherapy diem 00
S9339 Hit periton dialysis diem 00
S9340 Hit enteral per diem 00
S9341 Hit enteral grav diem 00
S9342 Hit enteral pump diem 00
S9343 Hit enteral bolus nurs 00
S9345 Hit anti-hemophil diem 00
S9346 Hit alpha-1-proteinas diem 00
S9347 Hit longterm infusion diem 00
S9348 Hit sympathomim diem 00
S9349 Hit tocolysis diem 00
S9351 Hit cont antiemetic diem 00
S9353 Hit cont insulin diem 00
S9355 Hit chelation diem 00
S9357 Hit enzyme replace diem 00
S9359 Hit anti-tnf per diem 00
S9361 Hit diuretic infus diem 00
S9363 Hit anti-spasmotic diem 00
S9364 Hit tpn total diem 00
S9365 Hit tpn 1 liter diem 00
S9366 Hit tpn 2 liter diem 00
S9367 Hit tpn 3 liter diem 00
S9368 Hit tpn over 3l diem 00
S9370 Ht inj antiemetic diem 00
S9372 Ht inj anticoag diem 00
S9373 Hit hydra total diem 00
S9374 Hit hydra 1 liter diem 00
S9375 Hit hydra 2 liter diem 00
S9376 Hit hydra 3 liter diem 00
S9377 Hit hydra over 3l diem 00
S9379 Hit noc per diem 00
S9381 Hit high risk/escort 00
S9401 Anticoag clinic per session 00
S9430 Pharmacy comp/disp serv 00
S9432 Med food non inborn err meta 00
S9433 Medical food oral 100% nutr 00
S9434 Mod solid food suppl 00
S9435 Medical foods for inborn err 00
S9436 Lamaze class 00
S9437 Childbirth refresher class 00
S9438 Cesarean birth class 00
S9439 Vbac class 00
S9441 Asthma education 00
S9442 Birthing class 00
S9443 Lactation class 00
S9444 Parenting class 00
S9445 Pt education noc individ 00
S9446 Pt education noc group 00
S9447 Infant safety class 00
S9449 Weight mgmt class 00
S9451 Exercise class 00
S9452 Nutrition class 00
S9453 Smoking cessation class 00
S9454 Stress mgmt class 00
S9455 Diabetic management program, 00
S9460 Diabetic management program, 00
S9465 Diabetic management program, 00
S9470 Nutritional counseling, diet 00
S9472 Cardiac rehabilitation progr 00
S9473 Pulmonary rehabilitation pro 00
S9474 Enterostomal therapy by a re 00
S9475 Ambulatory setting substance 00
S9476 Vestibular rehab per diem 00
S9480 Intensive outpatient psychia 00
S9482 Family stabilization 15 min 00
S9484 Crisis intervention per hour 00
S9485 Crisis intervention mental h 00
S9490 Hit corticosteroid/diem 00
S9494 Hit antibiotic total diem 00
S9497 Hit antibiotic q3h diem 00
S9500 Hit antibiotic q24h diem 00
S9501 Hit antibiotic q12h diem 00
S9502 Hit antibiotic q8h diem 00
S9503 Hit antibiotic q6h diem 00
S9504 Hit antibiotic q4h diem 00
S9529 Venipuncture home/snf 00
S9537 Ht hem horm inj diem 00
S9538 Hit blood products diem 00
S9542 Ht inj noc per diem 00
S9558 Ht inj growth horm diem 00
S9559 Hit inj interferon diem 00
S9560 Ht inj hormone diem 00
S9562 Ht inj palivizumab/ab diem 00
S9563 Ht inj immuno diem 00
S9590 Ht irrigation diem 00
S9810 Ht pharm per hour 00
S9900 Christian sci pract visit 00
S9901 Christian sci nurse visit 00
S9960 Air ambulanc nonemerg fixed 00
S9961 Air ambulan nonemerg rotary 00
S9970 Health club membership yr 00
S9975 Transplant related per diem 00
S9976 Lodging per diem 00
S9977 Meals per diem 00
S9981 Med record copy admin 00
S9982 Med record copy per page 00
S9986 Not medically necessary svc 00
S9988 Serv part of phase i trial 00
S9989 Services outside us 00
S9990 Services provided as part of 00
S9991 Services provided as part of 00
S9992 Transportation costs to and 00
S9994 Lodging costs (e.g. hotel ch 00
S9996 Meals for clinical trial par 00
S9999 Sales tax 00

Last reviewed: September 2026