S0023 Injection, cimetidine hydroc

Injection, cimetidine hydrochloride, 300 mg

Medicare pricing for S0023

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S0023

Payer coverage policies that name S0023

S0023 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaInjectable Medications (0020)listed, no stance (range S0021-S0081)Mar 5, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • CO: $12.50 (chp_plus, non-facility), effective Jul 1, 2026
  • ND: $0.00 (physician), effective Aug 1, 2026
  • WA: $3.15 (professional_administered_drugs), effective Jul 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.