HCPCS Code Section: HCPCS S Codes

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

Dextroamphetamine sulfate, 5 mg Short Description: Dextroamphetamine Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, 2004 Effective Date: April 1, …

Injection, menotropins, 75 iu Short Description: Inj menotropins 75 iu Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, 2002 Effective …

Becaplermin gel 0.01%, 0.5 gm Short Description: Becaplermin gel 1%, 0.5 gm Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, …

Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) Short Description: Ondansetron 4 mg Coverage Code: Not payable by Medicare Action Code: No …

Exemestane, 25 mg Short Description: Exemestane, 25 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2001 Effective Date: January …

Tretinoin, topical, 5 grams Short Description: Tretinoin topical 5 g Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: July 1, 2004 Effective …

Sterile dilutant for epoprostenol, 50 ml Short Description: Epoprostenol dilutant Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective …

Methadone, oral, 5 mg Short Description: Methadone oral 5mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: October 1, 2004 Effective Date: …

Injection, pegylated interferon alfa-2b, 10 mcg Short Description: Peg interferon alfa-2b/10 Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: October 1, 2010 …