Summary & Overview
HCPCS S5552: Insulin, Intermediate-Acting (NPH or Lente); 5 Units
HCPCS Level II code S5552 denotes 5 units of intermediate-acting insulin (NPH or lente). This supply code matters nationally because insulin access and billing affect outpatient diabetes management, cost sharing, and formulary decisions across public and private payers. The code is used when specific quantities of intermediate-acting insulin are furnished or dispensed in ambulatory settings.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context for intermediate-acting insulin, typical sites of service where S5552 is reported, and the common billing considerations tied to pharmaceutical supply codes. The publication summarizes benchmark coverage patterns, payer-specific billing practices where available, and any notable policy considerations affecting reimbursement and claims reporting for insulin supplies.
This summary is intended for billing professionals, policy analysts, and clinicians seeking a national-level reference on how intermediate-acting insulin is coded and the payer landscape relevant to outpatient dispensing and supply billing.
Billing Code Overview
HCPCS Level II code S5552 represents insulin, intermediate acting (NPH or lente); 5 units. This code is used to bill for a specified quantity of intermediate-acting insulin supplied for patient use.
Service Type: Pharmaceutical / Drug administration (supply)
Typical Site of Service: Outpatient settings, clinics, physician offices, and other ambulatory care locations where insulin is furnished or dispensed to patients.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with insulin-dependent diabetes mellitus presenting to an outpatient clinic, home health visit, or skilled nursing facility for medication administration or dispensation. The encounter involves preparation and provision of intermediate-acting insulin (NPH or Lente) measured in a 5-unit increment or supply. Clinical workflow includes verification of physician order, reconciliation of current insulin regimen and blood glucose logs, calculation of dose, preparation of the 5-unit insulin vial or syringe, patient or caregiver education on storage and administration, documentation in the medical record, and billing using the HCPCS Level II code S5552. Typical sites of service are ambulatory clinic, physician office, home health, skilled nursing facility, and pharmacy-dispensed outpatient settings. The patient scenario often includes monitoring for hypoglycemia, adjustment of concomitant short- or long-acting insulin, and coordination with primary care or endocrinology for ongoing diabetes management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier/standard billing | Used when no special circumstance applies and standard payment is expected. |
22 |