S0091 Granisetron 1mg

Granisetron hydrochloride, 1 mg (for circumstances falling under the medicare statute, use q0166)

Medicare pricing for S0091

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S0091

Payer coverage policies that name S0091

S0091 appears in 3 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAntiemetic Therapy (0724)listed, no stanceJul 17, 2026payer document
AetnaGastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy (0678)listed, no stanceOct 7, 2025payer document
AetnaInjectable Medications (0020)listed, no stance (range S0091-S0093)Mar 5, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 1, 2026
  • WA: $1.09 (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.