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See a sample rate comparisonHCPCS S4993 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.
Contraceptive pills for birth control
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Miscellaneous Medications and Therapeutic Substances |
| Common Place of Service | 11 - Office None 71 - Public Health Clinic |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for S4993 |
National average reimbursement for HCPCS S4993 by major payers:
$109.73
$0.85
$1.74
$13.24
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HCPCS S4993
5 of 25 sample ratesHigher to lower in this preview
Emory University, Emory University Hospital
Emory University
$3.50Published rateWillamette Community Health Solutions, Cascade Health Solutions
Willamette Community Health Solutions
$0.79Published rateCamille Leider
$0.79Published rateJoanne O'Brien
$0.79Published rateRyan Billeaudeaux
Willamette Community Health Solutions
$0.79Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS S4993 vs. Other Miscellaneous Medications and Therapeutic Substances Codes
The HCPCS S4993 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 S4993 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 |
|---|---|---|
| S4991-HCPCS | Low | Nicotine patches, non-legend |
| S4993-HCPCS | Low | Contraceptive pills for birth control |
| S4995-HCPCS | Low | Smoking cessation gum |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S4993. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S4993 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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