HCPCS Code Section: HCPCS S Codes

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

Dialysis/stress vitamin supplement, oral, 100 capsules Short Description: Vitamin suppl 100 caps Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, …

Calcitrol, 0.25 microgram Short Description: Calcitrol Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: October 1, 2010 Effective Date: October 1, 2010 …

Misoprostol, oral, 200 mcg Short Description: Misoprostol, oral, 200 mcg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2001 Effective …

Injection, olanzapine, 2.5 mg Short Description: Inj olanzapine 2.5mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: October 1, 2004 Effective Date: …

Mifepristone, oral, 200 mg Short Description: Mifepristone, oral, 200 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2001 Effective …

Injection, pantoprazole sodium, 40 mg Short Description: Injection pantroprazole Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: April 1, 2004 Effective Date: …

Testosterone pellet, 75 mg Short Description: Testosterone pellet 75 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective …

Tamoxifen citrate, oral, 10 mg Short Description: Tamoxifen 10 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective …

Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164) Short Description: Prochlorperazine 5 mg Coverage Code: Not payable by Medicare Action Code: No maintenance …