`S0190` Mifepristone, oral, 200 mg

Mifepristone, oral, 200 mg

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S0190

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S0190

1 of 1 payer prior-auth lists that name S0190 require prior authorization or set conditions: Humana.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management

Payer coverage policies that name S0190

S0190 appears in 1 coverage policy from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (0788)	not covered	Nov 19, 2025	payer document

Recent prior-auth changes

Jan 1, 2025: PA removed, UnitedHealthcare

Medicaid fee-for-service

AZ: $43.00 (outpatient_hospital), effective Oct 1, 2024
IL: $68.33 (practitioner), effective Apr 1, 2021
IN: $44.62 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2024
KS: $50.50 (default, Exempt Physician), effective Mar 1, 2019
ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Jan 1, 2025
WA: $43.00 (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.

S0190 Mifepristone, oral, 200 mg