`S0171` Bumetanide 0.5 mg

Injection, bumetanide, 0.5 mg

Medicare coverage: Not payable by Medicare
Status: terminated 20231231

Payer policies and prior authorization for S0171

Payer coverage policies that name S0171

S0171 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Injectable Medications (0020)	listed, no stance	Mar 5, 2026	payer document

Medicaid fee-for-service

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.

S0171 Bumetanide 0.5 mg

Payer policies and prior authorization for S0171

Payer coverage policies that name S0171

Medicaid fee-for-service

`S0171` Bumetanide 0.5 mg