HCPCS Range Miscellaneous Medications and Therapeutic Substances

• 1 Nicotine patches, legend ( S4990 )

• 2 Nicotine patches, non-legend ( S4991 )

• 3 Contraceptive pills for birth control ( S4993 )

• 4 Smoking cessation gum ( S4995 )

• 5 Prescription drug, generic ( S5000 )

• 6 Prescription drug, brand name ( S5001 )

• 7 5% dextrose and 0.45% normal saline, 1000 ml ( S5010 )

• 8 5% dextrose with potassium chloride, 1000 ml ( S5012 )

• 9 5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1000 ml ( S5013 )

• 10 5% dextrose/0.45% normal saline with potassium chloride and magnesium sulfate, 1500 ml ( S5014 )