HCPCS Code Section: HCPCS S Codes

Injection, metronidazole, 500 mg Short Description: Injection, metronidazole Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2000 Effective Date: January …

Injection, morphine sulfate, 500 mg (loading dose for infusion pump) Short Description: Morphine 500 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date …

Injection, famotidine, 20 mg Short Description: Injection, famotidine, 20 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2000 Effective …

Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump) Short Description: Hydromorphone 250 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date …

Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166) Short Description: Granisetron 1mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this …

Sildenafil citrate, 25 mg Short Description: Sildenafil citrate, 25 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2000 Effective …

Didanosine (ddi), 25 mg Short Description: Didanosine, 25 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, 2003 Effective Date: …

Clozapine, 25 mg Short Description: Clozapine, 25 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, 2003 Effective Date: April …

Injection, ganirelix acetate, 250 mcg Short Description: Inj ganirelix acetat 250 mcg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, …

Injection, follitropin beta, 75 iu Short Description: Inj follitropin beta 75 iu Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, …