HCPCS S0091 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Temporary National Codes (Non-Medicare) • Non-Medicare Drug Codes |
| Common Place of Service | • None • 11 - Office |
| Complexity Level | Low |
National average reimbursement for HCPCS S0091 by major payers:
$27.87
$3.44
$4.77
$27.13
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for HCPCS S0091 | ||||||
United | S0091 | $3.00 | 1518274414 - MICHELLE DAVILA | 931173927 | OR | Family Nurse Practitioner (363LF0000X) |
United | S0091 | $3.00 | 1437876026 - LAUREN CHASE | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Registered Dietitian (133V00000X) |
United | S0091 | $3.00 | 1962763185 - CELIA CHEUNG | 930593500 - (OR) DOCTORS EMERGENCY ROOM CORP PC | OR | Emergency Medicine Physician (207P00000X) |
United | S0091 | $3.00 | 1083994396 - TODD MORSE | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Physical Therapist (225100000X) |
United | S0091 | $3.00 | 1780639385 - LEE DAVIDSON | 930593500 - (OR) DOCTORS EMERGENCY ROOM CORP PC | OR | Emergency Medicine Physician (207P00000X) |
United | S0091 | $3.00 | 1972548766 - CAMILLE LEIDER | 931173927 | OR | Family Nurse Practitioner (363LF0000X) |
United | S0091 | $3.00 | 1528100310 - LESLIE HOFFMAN | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Hand Occupational Therapist (225XH1200X) |
United | S0091 | $3.75 | 1265415624 - WELLA AUGUSTINE | 930603212 - (OR) SLOCUM ORTHOPEDICS PC | OR | Physical Therapist (225100000X) |
United | S0091 | $3.00 | 1093196438 - TRACY BECKMANN | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Registered Dietitian (133V00000X) |
United | S0091 | $3.00 | 1750693552 - JUDITH EMMANERE | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Hand Occupational Therapist (225XH1200X) |
United | S0091 | $3.00 | 1457396442 - RICHARD ABRAHAM | 824794684 - (OR) OMHC LLC | OR | Emergency Medicine Physician (207P00000X) |
United | S0091 | $3.00 | 1134977564 - DYLAN GABLE | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Hand Occupational Therapist (225XH1200X) |
United | S0091 | $27.85 | 1437444619 - GAIL APTE | 920175033 | OR | Physical Therapist (225100000X) |
United | S0091 | $3.00 | 1831332097 - BRETT VECSEY | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | CA | Physical Therapist (225100000X) |
United | S0091 | $3.00 | 1902212863 - JOAN HARVEY | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Acute Care Nurse Practitioner (363LA2100X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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HCPCS S0091 vs. Other Non-Medicare Drug Codes Codes
The HCPCS S0091 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 S0091 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 |
|---|---|---|
| S0090-HCPCS | Low | Sildenafil citrate, 25 mg |
| S0091-HCPCS | Low | Granisetron hydrochloride, 1 mg (for circumstances falling under the Medicare statute, use Q0166) |
| S0092-HCPCS | Low | Injection, hydromorphone hydrochloride, 250 mg (loading dose for infusion pump) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S0091. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S0091 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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