S4995 Smoking cessation gum

Smoking cessation gum

Medicare pricing for S4995

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S4995

Payer coverage policies that name S4995

S4995 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaBack Pain - Invasive Procedures (0016)
Titanium triangular implants		listed, no stanceOct 6, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Aug 1, 2024

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.