S0255 Hospice refer visit nonmd

Hospice referral visit (advising patient and family of care options) performed by nurse, social worker, or other designated staff

Medicare pricing for S0255

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S0255

1 of 1 payer prior-auth lists that name S0255 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue).

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth under conditionssite of care: inpatient hospiceSep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)

Recent prior-auth changes

  • Jul 25, 2025: PA removed, Cigna
  • Jul 25, 2025: PA removed, Cigna

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 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.