Summary & Overview
HCPCS S0199: Medication-Induced Abortion Services (Non-Drug)
HCPCS Level II code S0199 represents the non-drug components of a medication-induced abortion delivered via oral administration, including counseling, office visits, pregnancy confirmation with hcg, and ultrasounds to determine gestational age and confirm completion. This code matters nationally as it captures bundled clinical and support services tied to medication abortion procedures, affecting billing, access, and coverage determinations across payers.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a clear description of the services captured by S0199, how common sites of care and service types align with billing practice, and which payers commonly encounter this code. The publication provides benchmarks where available, policy and coverage considerations relevant to billing non-drug abortion services, and clinical context on typical service components covered by the code. Data not available in the input for specific modifiers, associated taxonomies, ICD-10 diagnoses, related codes, and service line are noted as unavailable in applicable sections.
Billing Code Overview
HCPCS Level II code S0199 describes a medically induced abortion by oral ingestion of medication, encompassing all associated services and supplies except the drugs themselves. The code covers patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, and ultrasound to confirm completion of abortion.
Service Type: Medication-induced abortion services (non-drug components)
Typical Site of Service: Outpatient clinic or office setting, including family planning clinics and physician offices where counseling, testing, and ultrasound services are provided.
Clinical & Coding Specifications
Clinical Context
A 28-year-old patient presents to a clinic requesting a medication abortion at approximately 7 weeks' gestation confirmed by history and a positive urine pregnancy test. The clinical workflow includes an initial counseling visit that covers treatment options, informed consent, and review of contraindications. A serum or quantitative urine hCG (beta-hCG) is obtained to confirm pregnancy and establish a baseline. A transvaginal ultrasound is performed to confirm intrauterine pregnancy and estimate gestational age. If eligible, the patient receives detailed medication instructions for a medically induced abortion using prescribed drugs (drugs themselves are not included in this HCPCS Level II code). Follow-up includes an office visit within 7–14 days to assess completion of the abortion, which may include repeat hCG testing and/or a confirmatory ultrasound. Additional counseling, management of side effects (e.g., pain, bleeding), and documentation of completion are part of the bundled services described by S0199.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when unusual effort, time, or increased intensity is required for counseling or additional services beyond the usual for a medication abortion. |