HCPCS Code Section: HCPCS S Codes

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 …

Chlorambucil, oral, 2 mg Short Description: Chlorambucil 2 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective Date: …

Injection, bumetanide, 0.5 mg Short Description: Bumetanide 0.5 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective Date: …

Pneumococcal conjugate vaccine, polyvalent, intramuscular, for children from five years to nine years of age who have not previously received the vaccine Short Description: Pneumo vaccine 5-9 yrs Coverage …

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 …