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Unspecified Medication Codes with Charges Over $500

Date: 09/19/25

New PA Requirement for Unspecified Medication Codes with Charges Over $500

Effective October 20, 2025

Effective October 20, 2025, S5000 and S5001 require prior authorization (PA) if billed charges exceed $500.

Description

  • S5000 is a temporary national code used to identify a generic prescription drug. Part of the HCPCS level II codes used for billing and reimbursement for healthcare services and supplies. S5000 is used for generic medications prescribed by a healthcare provider.
  •  S5001 is a temporary national code used to identify a brand name prescription drug. It falls under the “Miscellaneous Medications and Therapeutic Substances” category as maintained by the Centers for Medicare & Medicaid Services (CMS). S5001 is used for brand name medications prescribed by a healthcare provider.

Note: S5000 and S5001 should only be billed when no other more specific code is available.

Questions? Contact your Provider Engagement Account Manager. If you need your Provider Engagement Account Manager’s contact information, email: AzCHProviderEngagement@azcompletehealth.com.