S9542 Ht inj noc per diem

Home injectable therapy, not otherwise classified, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem

Medicare pricing for S9542

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S9542

1 of 1 payer prior-auth lists that name S9542 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJan 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name S9542

S9542 appears in 11 coverage policies from Aetna, Anthem, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaHome Health Aides (0218)listed, no stance (range S9490-S9810)Sep 10, 2026payer document
AetnaSkilled Home Private Duty Nursing Care (0136)listed, no stance (range S9490-S9810)Apr 7, 2026payer document
AnthemHome Health (CG-MED-23)covered if criteria are metNov 6, 2025payer document
UnitedHealthcareHome Health Care Services (for Kentucky Only) (CS137KY.12)listed, no stanceJul 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (MP.022.28)listed, no stanceJul 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (CS137.X)listed, no stanceJul 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Kansas Only) (CS137KS.04)listed, no stanceSep 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Nebraska Only) (CS137NE.V)listed, no stanceJan 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for New Mexico Only) (CS137NM.D)listed, no stanceSep 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Ohio Only) (CS137OH.E)listed, no stanceAug 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Tennessee Only) (CS137TN1.J)listed, no stanceJan 1, 2026payer document

Recent prior-auth changes

  • Apr 1, 2026: PA added, Blue Cross and Blue Shield of Texas

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • KY: $10.00 (dme), effective Jan 1, 2026
  • MA: $9.62 (dme_rates), effective Mar 1, 2026
  • 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.