S9986Not medically necessary service (patient is aware that service not medically necessary)

Long descriptor

Not medically necessary service (patient is aware that service not medically necessary)

Short descriptor

Not medically necessary svc

Code family

S — Temporary national codes (non-Medicare)

Status

Active

Added to HCPCS

Jan 1, 2002

Action effective date

Jan 1, 2002

Termination date

None

Medicare coverage code

I — Not payable by Medicare

Pricing indicator

00 — Not separately priced by Part B

NOC list

On the CMS NOC code list

Maximum units per day (CMS Medically Unlikely Edits)

No published MUE for S9986. CMS keeps some MUE values confidential, so this does not mean there is no daily unit limit.

Quarterly history

No authoritative public data was located for this field.

No CMS NDC–HCPCS crosswalk rows were located. CMS notes its crosswalks are not a comprehensive list of all NDCs.

Drugs whose NDCs CMS crosswalks to S9986

No authoritative public data was located for this field.

• Coverage documents for S9986 NCDs, LCDs, and Billing & Coding articles in the CMS Medicare Coverage Database that mention “S9986”. Covered diagnosis codes are listed in the articles.
• Self-administered drug (SAD) exclusion lists Drugs each MAC excludes from “incident to” Part B coverage because they are usually self-administered.
• Find your Medicare contractor (MAC) A/B and DME MAC jurisdictions by state — local coverage and prior-authorization rules come from your MAC.
• CMS discarded drug (JW/JZ) guidance When the JW and JZ modifiers are required for drugs from single-dose containers.
• NCCI Medically Unlikely Edits CMS MUE tables and quarterly changes for practitioner, outpatient hospital, and DME claims.

Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.

All imported releases, checksums, and import reports are listed on the data sources page.

• Not otherwise classified (NOC/NOS) code on the CMS NOC code list. NOC codes are used when no specific code describes a product; claims commonly require additional information such as the drug name, NDC, dosage, and route. CodeRx never assigns a product to a specific NOC code unless a CMS file supports it.
• This is a non-Medicare code. Whether a payer recognizes it, and how it is paid, varies by payer and contract.
• A HCPCS code being valid does not mean Medicare or any other payer covers the item; coverage is determined by the payer and the MAC.
• CMS publishes NDC–HCPCS crosswalks to support ASP-based Part B payment; they are not a comprehensive list of NDCs that may be billed with this code.
• Payment limits are national Medicare Part B limits per billing unit, before deductible, coinsurance, and sequestration. They are not commercial payer rates.
• Hospital outpatient (OPPS) payment rates and status indicators are not included in this release.
• MUE values are the published CMS NCCI limits for Medicare fee-for-service claims; other payers may apply their own unit limits, and CMS keeps some MUE values confidential.