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S0136
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Procedure Codes
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HCPCS Level II
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Temporary National Codes (Non-Medicare)
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S0012–S0812
S0136
Clozapine, 25 mg
Back
S0012
Butorphanol tartrate, nasal spray, 25 mg
→
S0014
Tacrine hydrochloride, 10 mg
→
S0021
Injection, cefoperazone sodium, 1 gram
→
S0023
Injection, cimetidine hydrochloride, 300 mg
→
S0034
Injection, ofloxacin, 400 mg
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S0040
Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams
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S0078
Injection, fosphenytoin sodium, 750 mg
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S0081
Injection, piperacillin sodium, 500 mg
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S0088
Imatinib, 100 mg
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S0090
Sildenafil citrate, 25 mg
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S0091
Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166)
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S0092
Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump)
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S0093
Injection, morphine sulfate, 500 mg (loading dose for infusion pump)
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S0104
Zidovudine, oral, 100 mg
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S0106
Bupropion hcl sustained release tablet, 150 mg, per bottle of 60 tablets
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S0108
Mercaptopurine, oral, 50 mg
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S0109
Methadone, oral, 5 mg
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S0117
Tretinoin, topical, 5 grams
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S0119
Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code)
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S0122
Injection, menotropins, 75 iu
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S0126
Injection, follitropin alfa, 75 iu
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S0128
Injection, follitropin beta, 75 iu
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S0132
Injection, ganirelix acetate, 250 mcg
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S0136
Clozapine, 25 mg
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S0137
Didanosine (ddi), 25 mg
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S0138
Finasteride, 5 mg
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S0139
Minoxidil, 10 mg
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S0140
Saquinavir, 200 mg
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S0142
Colistimethate sodium, inhalation solution administered through dme, concentrated form, per mg
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S0145
Injection, pegylated interferon alfa-2a, 180 mcg per ml
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S0148
Injection, pegylated interferon alfa-2b, 10 mcg
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S0155
Sterile dilutant for epoprostenol, 50 ml
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S0156
Exemestane, 25 mg
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S0157
Becaplermin gel 0.01%, 0.5 gm
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S0160
Dextroamphetamine sulfate, 5 mg
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S0169
Calcitrol, oral, 0.25 microgram
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S0170
Anastrozole, oral, 1 mg
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S0172
Chlorambucil, oral, 2 mg
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S0174
Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)
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S0175
Flutamide, oral, 125 mg
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S0176
Hydroxyurea, oral, 500 mg
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S0177
Levamisole hydrochloride, oral, 50 mg
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S0178
Lomustine, oral, 10 mg
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S0179
Megestrol acetate, oral, 20 mg
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S0182
Procarbazine hydrochloride, oral, 50 mg
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S0183
Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164)
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S0187
Tamoxifen citrate, oral, 10 mg
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S0190
Mifepristone, oral, 200 mg
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S0191
Misoprostol, oral, 200 mcg
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S0194
Dialysis/stress vitamin supplement, oral, 100 capsules
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S0197
Prenatal vitamins, 30-day supply
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S0199
Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs
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S0201
Partial hospitalization services, less than 24 hours, per diem
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S0207
Paramedic intercept, non-hospital-based als service (non-voluntary), non-transport
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S0208
Paramedic intercept, hospital-based als service (non-voluntary), non-transport
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S0209
Wheelchair van, mileage, per mile
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S0215
Non-emergency transportation; mileage, per mile
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S0220
Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care (patient is present); approximately 30 minutes
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S0221
Medical conference by a physician with interdisciplinary team of health professionals or representatives of community agencies to coordinate activities of patient care (patient is present); approximately 60 minutes
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S0250
Comprehensive geriatric assessment and treatment planning performed by assessment team
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S0255
Hospice referral visit (advising patient and family of care options) performed by nurse, social worker, or other designated staff
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S0257
Counseling and discussion regarding advance directives or end of life care planning and decisions, with patient and/or surrogate (list separately in addition to code for appropriate evaluation and management service)
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S0260
History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service)
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S0265
Genetic counseling, under physician supervision, each 15 minutes
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S0270
Physician management of patient home care, standard monthly case rate (per 30 days)
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S0271
Physician management of patient home care, hospice monthly case rate (per 30 days)
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S0272
Physician management of patient home care, episodic care monthly case rate (per 30 days)
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S0273
Physician visit at member's home, outside of a capitation arrangement
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S0274
Nurse practitioner visit at member's home, outside of a capitation arrangement
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S0280
Medical home program, comprehensive care coordination and planning, initial plan
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S0281
Medical home program, comprehensive care coordination and planning, maintenance of plan
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S0285
Colonoscopy consultation performed prior to a screening colonoscopy procedure
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S0302
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)
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S0310
Hospitalist services (list separately in addition to code for appropriate evaluation and management service)
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S0311
Comprehensive management and care coordination for advanced illness, per calendar month
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S0315
Disease management program; initial assessment and initiation of the program
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S0316
Disease management program, follow-up/reassessment
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S0317
Disease management program; per diem
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S0320
Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month
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S0340
Lifestyle modification program for management of coronary artery disease, including all supportive services; first quarter / stage
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S0341
Lifestyle modification program for management of coronary artery disease, including all supportive services; second or third quarter / stage
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S0342
Lifestyle modification program for management of coronary artery disease, including all supportive services; fourth quarter / stage
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S0353
Treatment planning and care coordination management for cancer, initial treatment
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S0354
Treatment planning and care coordination management for cancer, established patient with a change of regimen
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S0390
Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit
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S0395
Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic
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S0400
Global fee for extracorporeal shock wave lithotripsy treatment of kidney stone(s)
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S0500
Disposable contact lens, per lens
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S0504
Single vision prescription lens (safety, athletic, or sunglass), per lens
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S0506
Bifocal vision prescription lens (safety, athletic, or sunglass), per lens
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S0508
Trifocal vision prescription lens (safety, athletic, or sunglass), per lens
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S0510
Non-prescription lens (safety, athletic, or sunglass), per lens
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S0512
Daily wear specialty contact lens, per lens
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S0514
Color contact lens, per lens
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S0515
Scleral lens, liquid bandage device, per lens
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S0516
Safety eyeglass frames
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S0518
Sunglasses frames
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S0580
Polycarbonate lens (list this code in addition to the basic code for the lens)
→
S0581
Nonstandard lens (list this code in addition to the basic code for the lens)
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S0590
Integral lens service, miscellaneous services reported separately
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S0592
Comprehensive contact lens evaluation
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S0595
Dispensing new spectacle lenses for patient supplied frame
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S0596
Phakic intraocular lens for correction of refractive error
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S0601
Screening proctoscopy
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S0610
Annual gynecological examination, new patient
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S0612
Annual gynecological examination, established patient
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S0613
Annual gynecological examination; clinical breast examination without pelvic evaluation
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S0618
Audiometry for hearing aid evaluation to determine the level and degree of hearing loss
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S0620
Routine ophthalmological examination including refraction; new patient
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S0621
Routine ophthalmological examination including refraction; established patient
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S0622
Physical exam for college, new or established patient (list separately in addition to appropriate evaluation and management code)
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S0630
Removal of sutures; by a physician other than the physician who originally closed the wound
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S0800
Laser in situ keratomileusis (lasik)
→
S0810
Photorefractive keratectomy (prk)
→
S0812
Phototherapeutic keratectomy (ptk)
→
Procedure code
CODABLE
S0136
Clozapine, 25 mg
Part
HCPCS Level II
S
Temporary National Codes (Non-Medicare)
S0
S0012–S0812
Source
CMS — ICD-10-PCS FY2026, HCPCS Level II october 2026, Procedure Codes 2026.
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