S0136 Clozapine, 25 mg

Clozapine, 25 mg

Medicare pricing for S0136

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S0136

0 of 1 payer prior-auth lists that name S0136 require prior authorization or set conditions.

Recent prior-auth changes

  • Jan 1, 2025: PA removed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in IN, WA.

  • ND: $0.00 (physician), effective Aug 1, 2026
  • WA: $0.02 (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.