Summary & Overview
HCPCS S0190: Mifepristone, Oral, 200 mg
HCPCS Level II code S0190 denotes mifepristone, oral, 200 mg, a medication used in specified clinical protocols. As an HCPCS Level II supply code, it identifies the product supplied for outpatient treatment and billing purposes. Nationally, clear identification of pharmaceutical HCPCS codes matters for consistent coverage determination, claims adjudication, and formulary alignment across payers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the code and clinical context, payer coverage considerations, and the types of benchmarks and policy elements that typically inform utilization and reimbursement discussions for pharmaceutical HCPCS codes. The publication outlines what to expect in payer policies, common billing modifiers, and typical service settings for dispensing and use.
This summary provides a foundation for further sections that present benchmarking metrics, payer policy variations, and clinical context for appropriate use. Data not available in the input will be noted in the detailed sections.
Billing Code Overview
HCPCS Level II code S0190 represents mifepristone, oral, 200 mg. This medication is supplied orally and is used as a pharmacologic agent in procedures consistent with its clinical indications.
Service Type: Medication administration / outpatient oral medication supply
Typical Site of Service: Outpatient clinic, ambulatory care setting, or pharmacy-dispensed outpatient use
Clinical & Coding Specifications
Clinical Context
A typical patient is a reproductive-age individual seeking medical termination of a first-trimester pregnancy. The patient presents to an outpatient ambulatory clinic or family planning clinic and undergoes intake, informed consent, and eligibility assessment (gestational age confirmed by ultrasound or reliable last menstrual period, no contraindications such as chronic adrenal failure or long-term corticosteroid use). The clinical workflow includes: initial counseling and consent; baseline assessment (vital signs, Rh status, and limited labs as indicated); administration or dispensing of S0190 (mifepristone 200 mg, oral) on site or provision of the single 200 mg dose to take at home per clinic protocol; scheduling of follow-up medication (typically misoprostol) and follow-up visit or remote assessment to confirm completion of the procedure; and documentation of medication lot number, route, dose, and patient instructions. Typical site of service is outpatient ambulatory clinic, family planning clinic, or physician office; pharmacy dispensing for outpatient take-home use is also common. Patient scenarios may include medication abortion up to the gestational age supported by local protocols, management of missed or incomplete abortion in early pregnancy, or adjunct use in medically indicated pregnancy termination under approved indications.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service not distinct or unlisted for HCPCS Level II |