HCPCS S4991 Fee Schedule

HCPCS S4991 vs. Other Miscellaneous Medications and Therapeutic Substances Codes

The HCPCS S4991 code is part of the Temporary National Codes (Non-Medicare) services used for Miscellaneous Medications and Therapeutic Substances. 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 S4991 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.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S4991. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the S4991 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.