HCPCS Code Section: HCPCS S Codes

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 …

Injection, pegylated interferon alfa-2a, 180 mcg per ml Short Description: Peg interferon alfa-2a/180 Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: July …

Levamisole hydrochloride, oral, 50 mg Short Description: Levamisole 50 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective …

Hydroxyurea, oral, 500 mg Short Description: Hydroxyurea 500 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective Date: …

Flutamide, oral, 125 mg Short Description: Flutamide 125 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective Date: …

Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180) Short Description: Dolasetron 50 mg Coverage Code: Not payable by Medicare Action Code: No maintenance …