Summary & Overview
HCPCS Level II S0191: Misoprostol, Oral 200 mcg
HCPCS Level II code S0191 designates oral misoprostol 200 mcg supplied in a clinical setting. As a non‑Medicare drug supply code, it is used to bill for the medication itself when provided during outpatient encounters, most commonly in office visits. This code matters nationally because misoprostol is widely used across reproductive health and gynecologic care, and consistent coding supports accurate medication tracking, coverage determination, and billing transparency.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of clinical context for the drug supply, common claim pairings and associated office visit codes, and typical sites of service where S0191 appears. The publication summarizes payer coverage considerations and common coding practices used on outpatient service lines. It also highlights related procedural and drug codes that frequently appear on the same claim to aid billing accuracy. Where input data is incomplete, the text notes "Data not available in the input."
Billing Code Overview
HCPCS Level II code S0191 represents Misoprostol, oral, 200 mcg supplied for clinical use. This is classified as a drug administration / supply code (HCPCS Level II, Non‑Medicare Drug Code). The typical site of service for claims using this code is an office setting (POS 11).
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Clinical & Coding Specifications
Clinical Context
A reproductive-age patient presents to the office seeking medical management for heavy menstrual bleeding or contraceptive care. The clinician discusses options and prescribes oral misoprostol, 200 mcg, for indicated use such as medical management of early pregnancy loss or adjunctive therapy as clinically appropriate. The medication is dispensed or administered in the office (Place of Service 11). The visit typically includes assessment, counseling, and documentation of informed consent, followed by supply or administration of the HCPCS Level II code S0191. Billing occurs for the drug supply using HCPCS Level II code S0191, and a separate evaluation and management visit may be billed if a significant, separately identifiable service is performed on the same day.
Coding Specifications
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Modifier
25: Use when a significant, separately identifiable evaluation and management (E/M) service is provided by the same physician on the same day as the HCPCS Level II codeS0191. Apply when documentation supports an E/M beyond usual pre-administration counseling. -
Modifier
59: Use to indicate a distinct procedural service whenS0191is billed on the same day as another procedure or service that would otherwise be bundled; apply only when clinical documentation supports that the services are separate and distinct.