HCPCS S9056 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Temporary National Codes (Non-Medicare) Miscellaneous Supplies and Services |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Complexity Level | Low |
National average reimbursement for HCPCS S9056 by major payers:
$114.23
$50.33
$19.27
$159.00
HCPCS S9056 vs. Other Miscellaneous Supplies and Services Codes
The HCPCS S9056 code is part of the Temporary National Codes (Non-Medicare) services used for Miscellaneous Supplies and Services. 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 S9056 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 |
|---|---|---|
| S9055-HCPCS | Moderate | Procuren or other growth factor preparation to promote wound healing |
| S9056-HCPCS | Low | Coma stimulation per diem |
| S9061-HCPCS | Low | Home administration of aerosolized drug therapy (e.g., pentamidine); administrative services, professional pharmacy services, care coordination, all necessary supplies and equipment (drugs and nursing visits coded separately), per diem |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S9056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S9056 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like HCPCS S9056) and we'll show you how you compare in 15 minutes or less.