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See a sample rate comparisonHCPCS S5551 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.
Insulin, most rapid onset (Lispro or Aspart); 5 units
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Insulin and Delivery Devices |
| Common Place of Service | None 11 - Office 23 - Emergency Room |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for S5551 |
National average reimbursement for HCPCS S5551 by major payers:
$0.41
$0.44
$1.51
$0.45
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HCPCS S5551
5 of 25 sample ratesHigher to lower in this preview
Andrea Leiserowitz
Willamette Community Health Solutions
$0.43Published rateTodd Morse
Willamette Community Health Solutions
$0.43Published rateLeo Cytrynbaum
Peacehealth
$0.43Published rateJulie Staub
Willamette Community Health Solutions
$0.43Published rateMarcus Braman
Doctors Emergency Room Corp PC
$0.43Published rate
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See a sample payer proposalHCPCS S5551 vs. Other Insulin and Delivery Devices Codes
The HCPCS S5551 code is part of the Temporary National Codes (Non-Medicare) services used for Insulin and Delivery Devices. 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 S5551 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 |
|---|---|---|
| S5550-HCPCS | Low | Insulin, rapid onset, 5 units |
| S5551-HCPCS | Low | Insulin, most rapid onset (Lispro or Aspart); 5 units |
| S5552-HCPCS | Low | Insulin, intermediate acting (NPH or LENTE); 5 units |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S5551. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S5551 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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