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See a sample rate comparisonHCPCS S0172 Fee Schedule
Last Verified: September 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.
Chlorambucil, oral, 2 mg
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Non-Medicare Drug Codes |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for S0172 |
National average reimbursement for HCPCS S0172 by major payers:
$292.78
$296.39
$268.72
$186.87
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HCPCS S0172
5 of 25 sample ratesHigher to lower in this preview
Chu Chen
$554.72Published rateLeif Meyers
Doctors Emergency Room Corp PC
$264.14Published rateJonell Blase
Doctors Emergency Room Corp PC
$264.14Published ratePamela Cotton
Doctors Emergency Room Corp PC
$264.14Published rateCelia Cheung
Doctors Emergency Room Corp PC
$264.14Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS S0172 vs. Other Non-Medicare Drug Codes Codes
The HCPCS S0172 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 S0172 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 |
|---|---|---|
| S0172-HCPCS | Moderate | Chlorambucil, oral, 2 mg |
| S0174-HCPCS | Low | Dolasetron mesylate, oral 50 mg (for circumstances falling under the Medicare statute, use Q0180) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S0172. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S0172 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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