HCPCS S0175 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 |
| Complexity Level | Low |
National average reimbursement for HCPCS S0175 by major payers:
$24.27
$36.22
$30.28
$21.67
| 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 S0175 | ||||||
United | S0175 | $35.93 | 1457396442 - RICHARD ABRAHAM | 263095354 - (OR) ICCO, LLC. | OR | Emergency Medicine Physician (207P00000X) |
United | S0175 | $35.93 | 1962763185 - CELIA CHEUNG | 930593500 - (OR) DOCTORS EMERGENCY ROOM CORP PC | OR | Emergency Medicine Physician (207P00000X) |
United | S0175 | $35.93 | 1851609945 - KRISTI WALLACE | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Family Nurse Practitioner (363LF0000X) |
United | S0175 | $79.07 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | S0175 | $35.94 | 1578583647 - MARC STIEFEL | 202604678 - PINNACLE ENT ALLIANCE, LLC | PA | Otolaryngology Physician (207Y00000X) |
United | S0175 | $75.47 | 1073502985 - CHU CHEN | 42484572 | MA | Pediatrics Physician (208000000X) |
United | S0175 | $35.93 | 1437436672 - COLLEEN TUMAN | 930593500 - (OR) DOCTORS EMERGENCY ROOM CORP PC | OR | Family Nurse Practitioner (363LF0000X) |
United | S0175 | $35.93 | 1841762002 - CAITLIN MYERS | 930593500 - (OR) DOCTORS EMERGENCY ROOM CORP PC | OR | Family Medicine Physician (207Q00000X) |
United | S0175 | $35.93 | 1285658625 - ANN BOWERS | 263095354 - (OR) ICCO, LLC. | OR | Emergency Medicine Physician (207P00000X) |
United | S0175 | $35.93 | 1972295574 - AURORA MARTIN | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Physical Therapist (225100000X) |
United | S0175 | $35.93 | 1902212863 - JOAN HARVEY | 930636837 - (OR) OREGON UROLOGY INSTITUTE PC | OR | Acute Care Nurse Practitioner (363LA2100X) |
United | S0175 | $35.93 | 1942629126 - AMBER VESTER | 931251530 | OR | Family Medicine Physician (207Q00000X) |
United | S0175 | $35.93 | 1811205248 - KATHERINE SCHOONOVER | 930421470 - (OR) WILLAMETTE COMMUNITY HEALTH SOLUTIONS | OR | Family Nurse Practitioner (363LF0000X) |
United | S0175 | $35.93 | 1811205248 - KATHERINE SCHOONOVER | 832849989 - ZOOMCARE | OR | Family Nurse Practitioner (363LF0000X) |
United | S0175 | $35.93 | 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 S0175 vs. Other Non-Medicare Drug Codes Codes
The HCPCS S0175 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 S0175 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 |
|---|---|---|
| S0174-HCPCS | Low | Dolasetron mesylate, oral 50 mg (for circumstances falling under the Medicare statute, use Q0180) |
| S0175-HCPCS | Low | Flutamide, oral, 125 mg |
| S0176-HCPCS | Low | Hydroxyurea, oral, 500 mg |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S0175. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S0175 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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