S0155 Epoprostenol dilutant

Sterile dilutant for epoprostenol, 50 ml

Medicare pricing for S0155

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S0155

Payer coverage policies that name S0155

S0155 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaInjectable Medications (0020)listed, no stance (range S0145-S0156)Mar 5, 2026payer document
Blue Cross & Blue Shield of MississippiPulmonary Arterial Hypertension (L.5.01.465)covered if criteria are metpayer document
BlueCross BlueShield of South CarolinaAdvanced Therapies for Pharmacologic Treatment of Pulmonary Hypertension (CAM 50109)listed, no stanceJul 1, 2026payer document
CignaPulmonary Arterial Hypertension – Epoprostenol Products (IP0762)covered if criteria are metJun 15, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 1, 2026
  • WA: $14.50 (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.