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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)
BackS0012Butorphanol tartrate, nasal spray, 25 mg→S0014Tacrine hydrochloride, 10 mg→S0021Injection, cefoperazone sodium, 1 gram→S0023Injection, cimetidine hydrochloride, 300 mg→S0034Injection, ofloxacin, 400 mg→S0040Injection, ticarcillin disodium and clavulanate potassium, 3.1 grams→S0078Injection, fosphenytoin sodium, 750 mg→S0081Injection, piperacillin sodium, 500 mg→S0088Imatinib, 100 mg→S0090Sildenafil citrate, 25 mg→S0091Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166)→S0092Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump)→S0093Injection, morphine sulfate, 500 mg (loading dose for infusion pump)→S0104Zidovudine, oral, 100 mg→S0106Bupropion hcl sustained release tablet, 150 mg, per bottle of 60 tablets→S0108Mercaptopurine, oral, 50 mg→S0109Methadone, oral, 5 mg→S0117Tretinoin, topical, 5 grams→S0119Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code)→S0122Injection, menotropins, 75 iu→S0126Injection, follitropin alfa, 75 iu→S0128Injection, follitropin beta, 75 iu→S0132Injection, ganirelix acetate, 250 mcg→S0136Clozapine, 25 mg→S0137Didanosine (ddi), 25 mg→S0138Finasteride, 5 mg→S0139Minoxidil, 10 mg→S0140Saquinavir, 200 mg→S0142Colistimethate sodium, inhalation solution administered through dme, concentrated form, per mg→S0145Injection, pegylated interferon alfa-2a, 180 mcg per ml→S0148Injection, pegylated interferon alfa-2b, 10 mcg→S0155Sterile dilutant for epoprostenol, 50 ml→S0156Exemestane, 25 mg→S0157Becaplermin gel 0.01%, 0.5 gm→S0160Dextroamphetamine sulfate, 5 mg→S0169Calcitrol, oral, 0.25 microgram→S0170Anastrozole, oral, 1 mg→S0172Chlorambucil, oral, 2 mg→S0174Dolasetron mesylate, oral 50 mg (for circumstances falling under the medicare statute, use q0180)→S0175Flutamide, oral, 125 mg→S0176Hydroxyurea, oral, 500 mg→S0177Levamisole hydrochloride, oral, 50 mg→S0178Lomustine, oral, 10 mg→S0179Megestrol acetate, oral, 20 mg→S0182Procarbazine hydrochloride, oral, 50 mg→S0183Prochlorperazine maleate, oral, 5 mg (for circumstances falling under the medicare statute, use q0164)→S0187Tamoxifen citrate, oral, 10 mg→S0190Mifepristone, oral, 200 mg→S0191Misoprostol, oral, 200 mcg→S0194Dialysis/stress vitamin supplement, oral, 100 capsules→S0197Prenatal vitamins, 30-day supply→S0199Medically 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→S0201Partial hospitalization services, less than 24 hours, per diem→S0207Paramedic intercept, non-hospital-based als service (non-voluntary), non-transport→S0208Paramedic intercept, hospital-based als service (non-voluntary), non-transport→S0209Wheelchair van, mileage, per mile→S0215Non-emergency transportation; mileage, per mile→S0220Medical 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→S0221Medical 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→S0250Comprehensive geriatric assessment and treatment planning performed by assessment team→S0255Hospice referral visit (advising patient and family of care options) performed by nurse, social worker, or other designated staff→S0257Counseling 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)→S0260History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service)→S0265Genetic counseling, under physician supervision, each 15 minutes→S0270Physician management of patient home care, standard monthly case rate (per 30 days)→S0271Physician management of patient home care, hospice monthly case rate (per 30 days)→S0272Physician management of patient home care, episodic care monthly case rate (per 30 days)→S0273Physician visit at member's home, outside of a capitation arrangement→S0274Nurse practitioner visit at member's home, outside of a capitation arrangement→S0280Medical home program, comprehensive care coordination and planning, initial plan→S0281Medical home program, comprehensive care coordination and planning, maintenance of plan→S0285Colonoscopy consultation performed prior to a screening colonoscopy procedure→S0302Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)→S0310Hospitalist services (list separately in addition to code for appropriate evaluation and management service)→S0311Comprehensive management and care coordination for advanced illness, per calendar month→S0315Disease management program; initial assessment and initiation of the program→S0316Disease management program, follow-up/reassessment→S0317Disease management program; per diem→S0320Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month→S0340Lifestyle modification program for management of coronary artery disease, including all supportive services; first quarter / stage→S0341Lifestyle modification program for management of coronary artery disease, including all supportive services; second or third quarter / stage→S0342Lifestyle modification program for management of coronary artery disease, including all supportive services; fourth quarter / stage→S0353Treatment planning and care coordination management for cancer, initial treatment→S0354Treatment planning and care coordination management for cancer, established patient with a change of regimen→S0390Routine foot care; removal and/or trimming of corns, calluses and/or nails and preventive maintenance in specific medical conditions (e.g., diabetes), per visit→S0395Impression casting of a foot performed by a practitioner other than the manufacturer of the orthotic→S0400Global fee for extracorporeal shock wave lithotripsy treatment of kidney stone(s)→S0500Disposable contact lens, per lens→S0504Single vision prescription lens (safety, athletic, or sunglass), per lens→S0506Bifocal vision prescription lens (safety, athletic, or sunglass), per lens→S0508Trifocal vision prescription lens (safety, athletic, or sunglass), per lens→S0510Non-prescription lens (safety, athletic, or sunglass), per lens→S0512Daily wear specialty contact lens, per lens→S0514Color contact lens, per lens→S0515Scleral lens, liquid bandage device, per lens→S0516Safety eyeglass frames→S0518Sunglasses frames→S0580Polycarbonate lens (list this code in addition to the basic code for the lens)→S0581Nonstandard lens (list this code in addition to the basic code for the lens)→S0590Integral lens service, miscellaneous services reported separately→S0592Comprehensive contact lens evaluation→S0595Dispensing new spectacle lenses for patient supplied frame→S0596Phakic intraocular lens for correction of refractive error→S0601Screening proctoscopy→S0610Annual gynecological examination, new patient→S0612Annual gynecological examination, established patient→S0613Annual gynecological examination; clinical breast examination without pelvic evaluation→S0618Audiometry for hearing aid evaluation to determine the level and degree of hearing loss→S0620Routine ophthalmological examination including refraction; new patient→S0621Routine ophthalmological examination including refraction; established patient→S0622Physical exam for college, new or established patient (list separately in addition to appropriate evaluation and management code)→S0630Removal of sutures; by a physician other than the physician who originally closed the wound→S0800Laser in situ keratomileusis (lasik)→S0810Photorefractive keratectomy (prk)→S0812Phototherapeutic keratectomy (ptk)→
Procedure codeCODABLE
S0302
Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)
CODING INFORMATION
"S" CODES ARE UNIQUE TEMPORARY CODES ESTABLISHED BY BCBSA AND HIAA FOR PRIVATE PAYOR USE. THEY ARE NOT VALID NOR PAYABLE BY MEDICARE.
- 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.