Summary & Overview
HCPCS S0012: Butorphanol Tartrate Nasal Spray, 25 mg
HCPCS Level II code S0012 denotes butorphanol tartrate nasal spray, 25 mg — an intranasal opioid-agonist/antagonist used for acute pain management in ambulatory and emergency settings. Nationally, a specific HCPCS Level II code for a branded or formulation-specific medication supports consistent billing, inventory tracking, and payer claims processing across outpatient clinics and emergency departments.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise clinical description, the common sites of service where S0012 is applied, and an outline of which payers typically cover this HCPCS medication code. The publication provides benchmark context for coverage and billing practice comparisons, highlights relevant clinical use cases for intranasal butorphanol, and summarizes common billing modifiers and administrative considerations.
This summary is intended for revenue-cycle managers, clinical administrators, and policy analysts seeking a national-level reference for coding and payer interactions related to HCPCS Level II code S0012. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code S0012 represents butorphanol tartrate nasal spray, 25 mg. This code denotes a prescription intranasal analgesic formulation of butorphanol tartrate intended for systemic pain management.
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Service type: Prescription nasal analgesic administration (intranasal medication)
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Typical site of service: Outpatient clinic, emergency department, or other ambulatory care settings where intranasal medication administration or dispensing occurs
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Clinical & Coding Specifications
Clinical Context
A 42-year-old female presents to an outpatient ambulatory surgery center with acute migraine refractory to oral analgesics and nausea that prevents oral therapy. The treating clinician administers S0012 (butorphanol tartrate, nasal spray, 25 mg) as an intranasal opioid agonist/partial agonist for rapid analgesia. The typical workflow includes triage and vital signs, assessment of pain severity and contraindications (respiratory depression, recent benzodiazepine use, allergy to butorphanol), informed consent emphasizing potential sedation and dizziness, administration of the intranasal spray, observation for 30–60 minutes for efficacy and adverse effects (sedation, respiratory status, hypotension), and documentation of dose, lot number, and patient response. The usual site of service is an outpatient clinic, emergency department, or ambulatory surgery/infusion center where intranasal medication administration and short observation are available.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no special billing modifier applies to the service. |
22 | Increased procedural services |