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HCPCS S9123: Nursing Care in the Home by Registered Nurse, Per Hour
HCPCS Level II code S9123 denotes hourly registered nurse (RN) services delivered in the patient’s home for general nursing care. This non-CPT home nursing code is used by clinicians and payers to document and process professional nursing hours outside institutional settings. Nationwide, home nursing services represented by codes like S9123 support chronic disease management, post-acute recovery, and care for patients with functional limitations who require skilled nursing attention at home.
Key payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. The analysis summarizes payer coverage characteristics, common clinical applications, and operational considerations for submitting and adjudicating claims with S9123.
Readers will learn how S9123 is defined and applied in home-care practice, how it relates to other home-visit and nursing codes, and which clinical scenarios commonly align with its use. The publication also outlines typical service settings and the roles of registered nurses in delivering billed services. Data not available in the input for detailed reimbursement benchmarks and payer-specific policy language.
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Billing Code Overview
HCPCS Level II code S9123 describes nursing care in the home provided by a registered nurse, billed per hour. The service is intended for general nursing care delivered at a patient’s residence and is not to be used when CPT codes 99500–99602 apply.
Service type: Home-based registered nursing care
Typical site of service: Patient home / residential setting
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.