HCPCS Code Section: HCPCS S Codes

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 …

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

Megestrol acetate, oral, 20 mg Short Description: Megestrol 20 mg Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective …

Non-emergency transportation; mileage, per mile Short Description: Nonemerg transp mileage Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, 2002 Effective …

Wheelchair van, mileage, per mile Short Description: Wc van mileage per mi Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, …

Paramedic intercept, hospital-based als service (non-voluntary), non-transport Short Description: Paramed intrcept nonvol Coverage Code: Not payable by Medicare Action Code: No maintenance for this code Date Added: January 1, …

Medical home program, comprehensive care coordination and planning, initial plan Short Description: Medical home, initial plan Coverage Code: Not payable by Medicare Action Code: No maintenance for this code …