Loading...

    Explore
    • Policy Monitoring
    • Live Policy Feed
    • Billing Codes
    • Healthcare Providers
    • Health Insurance Payers
    • States
    • Service Lines
    • Taxonomy Codes
    Lookup tools
    • Billing Code Lookup
    • CPT Modifier Lookup
    • Provider Taxonomy Code Lookup
    • Healthcare Provider & Facility Lookup
    • Health Insurance Payer Lookup
    • Payer Contact Directory

    Policy & Benchmark Tools

    • Prior Authorization Lookup
    • Coverage Criteria Lookup
    • Timely Filing Lookup
    • Billing Code Reimbursement Rates
    • Payer Comparison Dashboard
    • Facility Comparison Dashboard
    • All tools

    Company

    • About OpenPayer
    • Data Sources
    • Trek Health
    OpenPayerby Trek Health
    LinkedInYouTube

    © 2026 Trek Health. All rights reserved.

    OpenPayer is built and maintained by Trek Health.

    v1.0.30
    OpenPayerBilling CodesTemporary National Codes (Non-Medicare)HCPCS hcpcs-s9123-home-registered-nurse-hourly-care
    Ask Trek AI about this page

    HCPCS S9123: Nursing Care in Home by Registered Nurse, Per Hour

    HCPCS Level II code S9123 describes nursing care provided in the home by a registered nurse, billed per hour; the service type is skilled nursing services and the typical site of service is the patient's home for general nursing care when CPT home visit codes 99500–99602 are not applicable.

    For related coverage guidance, see recent payer policy updates: Medical Necessity Guidelines Non-Emergency Transportation, Non-Emergent Transportation Medical Policy, Non-Emergency Facility to Facility Transfers.

    Customize your policy alerts

    Sign up for hcpcs S9123 policy alerts

    Get alerted when payer policies referencing S9123 are released or updated.

    Monitor payer policy activity

    Receive email alerts as soon as relevant payer policies are published or updated.

    National Reimbursement Benchmarks

    Commercial reimbursement for HCPCS S9123 centers around a BUCA average commercial rate of $53.7, with notable payer-specific spreads. Blue Cross Blue Shield shows a wide interquartile range (P75–P25) of $14.1 ($64.3–$50.2), and Cigna displays an even wider IQR of $50.0 ($64.0–$14.0), indicating substantial variability within those contracts. UnitedHealth Group and Aetna are comparatively tight: UnitedHealth Group’s IQR is $5.5 ($61.0–$55.5) and Aetna’s IQR is effectively $0.0 ($30.0–$30.0), reflecting clustered commercial pricing for those payers.

    Maximum-to-minimum spreads also highlight dispersion: Cigna has a high ceiling ($213.4) well above its $14.0 floor, while Blue Cross Blue Shield’s max of $112.5 sits mid-range versus its $28.4 minimum. UnitedHealth Group’s values are concentrated near its median ($61.0) and BUCA’s mean represents a mid-market commercial benchmark at $53.7.

    Table of contents

    Progress1 / 8

    Explore openpayer tools

    • Billing CodesCPT, HCPCS, DRG & more
    • Reimbursement RatesCommercial vs. Medicare rate reports
    • Facility ComparisonBeds, revenue & payer mix
    • ProvidersHospitals & facilities
    • PayersPlans & market footprint
    • Taxonomy CodesNUCC specialty codes
    • ModifiersCPT modifiers & usage
    • Prior AuthorizationPA policies by payer & drug
    • Timely FilingFiling deadlines by payer
    • Coverage CriteriaMedical necessity by payer
    • Payer ContactsClaims, PA & appeals contacts
    View all tools
    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A homebound 78-year-old patient with bed confinement status (Z74.01) and dependence on a wheelchair (Z99.3) is discharged following orthopedic surgery and requires ongoing skilled nursing for medication administration, wound checks, and therapeutic drug level monitoring (Z51.81). A registered nurse from a Home Health Agency (taxonomy 251J00000X) provides hourly in-home nursing care billed with S9123. The clinical workflow: referral from the discharging hospital or primary care clinician; home visit by the registered nurse to perform assessment, medication reconciliation (including management of long-term anticoagulants Z79.01), wound care, documentation of aftercare needs (Z48.89), communication with the supervising clinician, and coordination of ongoing home-based services. Visits are documented with start/stop times, skilled nursing interventions performed, patient response, and plan for subsequent visits. Billing uses S9123 for general nursing care by a registered nurse, with appropriate ICD-10 codes appended to reflect bed confinement, aftercare, medication monitoring, anticoagulant use, and mobility dependence.

    Related CPT Codes

    CPT CodeDescription

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    163W00000X
    251J00000X
    163WC1500X
    2080P0208X
    261QR0200X
    364SS0200X
    171000000X
    364SP2800X

    Related Payer Policy Updates

    Specialty: Emergency & Medical Transportation1 / 3

    10 rows

    PolicyPayerEffective Date
    Medical Necessity Guidelines Non-Emergency TransportationMass General Brigham Health Plan2026-11-01
    Non-Emergent Transportation Medical PolicyHealth-New-England2026-11-01
    Non-Emergency Facility to Facility Transfershap_caresource_mi_coordinated_health2026-11-01
    Ambulance and Medical Transport Services (Ground, Air and Water) Corporate Medical Policybcbsvermont2026-10-01
    Emergency Air/Water Ambulance Services Medical GuidelineWPS Health Insurance2026-10-01
    Non-Emergent Ambulance ServicesConnectiCare2026-09-11
    Fixed Wing Air Ambulance TransportCigna2026-08-15
    Air AmbulanceAmbetter Georgia2026-08-01
    Ambulance Services (for Tennessee Only)UnitedHealthcare2026-08-01
    Ambulance Services (for New Mexico Only)UnitedHealthcare2026-08-01

    Related Codes

    HCPCS-LEVEL-II-S2152-SOLID-ORGAN-TRANSPLANTATION-GLOBAL-CARE

    HCPCS Level II S2152: Solid Organ Procurement and Transplantation

    HCPCS-LEVEL-II-S2266-INDUCED-ABORTION-29-TO-31-WEEKS

    HCPCS Level II S2266: Induced Abortion, 29 to 31 Weeks

    HCPCS-LEVEL-II-S3630-EOSINOPHIL-COUNT-BLOOD-DIRECT

    HCPCS Level II S3630: Eosinophil Count, Blood, Direct

    HCPCS-LEVEL-II-S4017-INCOMPLETE-ART-CYCLE-CANCELLED-PRIOR-TO-STIMULATION

    HCPCS Level II S4017: Incomplete Cycle — Cancelled Prior to Stimulation

    HCPCS-LEVEL-II-S8055-ULTRASOUND-GUIDANCE-MULTIFETAL-REDUCTION-TC

    HCPCS Level II S8055: Ultrasound Guidance for Multifetal Pregnancy Reduction

    HCPCS-LEVEL-II-S8940-EQUESTRIAN-HIPPOTHERAPY-PER-SESSION

    HCPCS Level II S8940: Equestrian/Hippotherapy, Per Session

    HCPCS-LEVEL-II-S9024-PARANASAL-SINUS-ULTRASOUND

    HCPCS Level II S9024: Paranasal Sinus Ultrasound

    HCPCS-LEVEL-II-S9366-HOME-TPN-1-2L-PER-DAY-HOME-INFUSION

    HCPCS Level II S9366: Home Infusion TPN, 1–2 L/day

    HCPCS-LEVEL-II-S9446-GROUP-PATIENT-EDUCATION-NON-PHYSICIAN

    HCPCS S9446: Patient Education, Non-Physician Provider, Group, Per Session

    HCPCS-LEVEL-II-S9451-EXERCISE-CLASS-NON-PHYSICIAN-SESSION

    HCPCS S9451: Exercise Classes, Non-Physician Provider, Per Session

    Showing 1–10 of 532

    • More pages

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
    Published by

    Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Relationship to This Procedure
    S9124Nursing care, in the home; by licensed practical nurse, per hourAlternative home nursing level; LPN provides services when tasks are within LPN scope and billed separately from RN services
    99501Home visit for postnatal assessment and follow-up careSpecific home visit code for postnatal/newborn assessment; not used simultaneously with general adult nursing home care code
    99502Home visit for newborn care and assessmentHome visit code for newborn care; relevant when home nursing includes newborn assessment services
    99600Unlisted home visit service or procedureUsed when a home visit service is not described by existing CPT/HCPCS codes and additional documentation is required