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See a sample rate comparisonHCPCS S0090 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Sildenafil citrate, 25 mg
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Non-Medicare Drug Codes |
| Common Place of Service | None 11 - Office 23 - Emergency Room |
| Complexity Level | Low |
National average reimbursement for HCPCS S0090 by major payers:
$7.14
$2.87
$1.52
$5.50
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HCPCS S0090
5 of 25 sample ratesHigher to lower in this preview
Gail Apte
$5.11Published rateLeo Cytrynbaum
Peacehealth
$0.27Published rateJudith Emmanere
Willamette Community Health Solutions
$0.27Published rateAnn Bowers
Franciscan Medical Group
$0.27Published rateKathy Meldrum
Willamette Community Health Solutions
$0.27Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS S0090 vs. Other Non-Medicare Drug Codes Codes
The HCPCS S0090 code is part of the Temporary National Codes (Non-Medicare) services used for Non-Medicare Drug Codes. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS S0090 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| S0088-HCPCS | Low | Imatinib, 100 mg |
| S0090-HCPCS | Low | Sildenafil citrate, 25 mg |
| S0091-HCPCS | Low | Granisetron hydrochloride, 1 mg (for circumstances falling under the Medicare statute, use Q0166) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S0090. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S0090 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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