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See a sample rate comparisonHCPCS S4991 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.
Nicotine patches, non-legend
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Miscellaneous Medications and Therapeutic Substances |
| Common Place of Service | None 11 - Office |
| Complexity Level | Low |
National average reimbursement for HCPCS S4991 by major payers:
$2.16
$1.78
$1.98
$2.20
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HCPCS S4991
5 of 25 sample ratesHigher to lower in this preview
Daniel Zimmerman
$1.79Published rateHospital Authority Of Washington County, Washington County Regional Medical Center
$1.77Published rateCaitlin Myers
Hiv Alliance
$1.77Published rateAndrea Leiserowitz
Willamette Community Health Solutions
$1.77Published rateJoan Harvey
Willamette Community Health Solutions
$1.77Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS 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.
| Code | Complexity | Description |
|---|---|---|
| S4990-HCPCS | Low | Nicotine patches, legend |
| S4991-HCPCS | Low | Nicotine patches, non-legend |
| S4993-HCPCS | Low | Contraceptive pills for birth control |
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.
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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