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See a sample rate comparisonHCPCS S5561 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 delivery device, reusable pen; 3 ml size
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Insulin and Delivery Devices |
| Common Place of Service | 11 - Office None 99 - Other POS 50 - Federally Qualified Health Center |
| Complexity Level | Low |
| Medicaid Fee Schedule | View Medicaid rates for S5561 |
National average reimbursement for HCPCS S5561 by major payers:
$37.62
$96.21
$43.28
$44.01
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HCPCS S5561
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See a sample payer proposalHCPCS S5561 vs. Other Insulin and Delivery Devices Codes
The HCPCS S5561 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 S5561 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 |
|---|---|---|
| S5560-HCPCS | Low | Insulin delivery device, reusable pen; 1.5 ml size |
| S5561-HCPCS | Low | Insulin delivery device, reusable pen; 3 ml size |
| S5565-HCPCS | Low | Insulin cartridge for use in insulin delivery device other than pump; 150 units |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S5561. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S5561 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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