HCPCS code S0122 – Menotropins injection

Key takeaways

HCPCS code S0122 reports menotropins injection (Menopur) in 75 IU units, so one 75 IU vial is one unit.

Menotropins is a urinary human menopausal gonadotropin with FSH and LH activity, which sets it apart from the recombinant FSH codes S0126 and S0128.

Many IVF protocols pair Menopur with a recombinant FSH, so one cycle can carry two drug lines, two NDCs and two authorized drugs.

Medicare does not recognize S-codes for payment, so S0122 goes to commercial payers, which usually require prior authorization.

Pabau, the practice management software we build, keeps the authorization code, dates and sessions on the patient’s case, with a warning when one is missing.

HCPCS code S0122: Definition and official descriptor

HCPCS code S0122 is defined as “Injection, menotropins, 75 IU” in the CMS HCPCS Level II code set. The billing unit is each 75 IU administered. The descriptor has stayed the same across HCPCS editions, so older crosswalks that map S0122 to another drug are wrong.

Menotropins is a purified human menopausal gonadotropin (hMG) extracted from the urine of postmenopausal women. It carries both follicle-stimulating hormone (FSH) and luteinizing hormone (LH) activity. The brand billed under S0122 in the US is Menopur, made by Ferring Pharmaceuticals.

S-codes are temporary national codes created for private payers, which use them where no permanent HCPCS code exists. Medicare does not pay them, so S0122 lives almost entirely on commercial claims.

What S0122 covers and what it excludes

S0122 covers menotropins only. The most frequent scope error is reporting Menopur under a follitropin code because both drugs sit in the same stimulation protocol.

Covered under S0122:

• Menopur (menotropins) injections for multiple follicle development in IVF and other assisted reproductive technology (ART) cycles
• Menotropins given alongside a recombinant FSH in a combined stimulation protocol, reported on its own claim line
• Menotropins for ovulation induction, where the payer’s policy covers that use

Not covered under S0122:

• Follitropin alfa, such as Gonal-F (use S0126)
• Follitropin beta, such as Follistim AQ (use S0128)
• Urofollitropin, chorionic gonadotropin (hCG) and GnRH drugs, which each have their own codes
• The injection service itself, which goes on a separate line with an administration code such as CPT 96372

The FDA label for Menopur covers ovulatory women in an ART cycle. Ovulation induction in anovulatory patients is an off-label use in the US, so some payers will not authorize it under S0122.

How to count units for S0122

Each Menopur vial is labeled 75 IU, and each unit of S0122 equals 75 IU. Count the vials administered, not the total of FSH and LH activity. Adding the two together doubles the unit count and invites an overbilling flag.

Menopur comes as a powder that is reconstituted with sterile saline. The label allows up to six vials to be dissolved in 1 mL of diluent for a single injection. One injection can therefore carry up to 6 units, so count the vials, not the syringes.

NDC reporting: Most commercial payers require the 11-digit National Drug Code (NDC) on the line with S0122. Report it after the N4 qualifier, with the NDC quantity and unit of measure. The NDC should match the Menopur package dispensed for that encounter.

Who bills the drug: Many patients inject Menopur at home after a specialty pharmacy fills the prescription. In that case the pharmacy usually bills the drug, and the practice bills only the services it performs. Confirm the route at eligibility so the same vials are not claimed twice.

Billing S0122 in a combined FSH and hMG protocol

Many IVF protocols add a daily Menopur dose to a recombinant FSH such as Gonal-F or Follistim AQ. Payers treat these as two drugs, so the claim carries two separate drug lines.

• Two codes: S0122 for the Menopur doses, plus S0126 or S0128 for the recombinant FSH
• Two unit counts: each line counts its own 75 IU increments, worked out separately
• Two NDCs: each line carries the NDC of the product dispensed
• Two authorized drugs: the prior authorization has to name both drugs, or the second line can deny

An authorization issued for “gonadotropins” in general may still list only one product. Read the approval letter before the cycle starts, and request an amendment if Menopur is missing. The chart below sets the two lines side by side, with the unit count for a typical three-vial dose.

S0122 vs S0126 vs S0128: Choosing the right code

The three gonadotropin S-codes share a 75 IU billing unit, which is why they get swapped. The drug on the package decides the code, and the descriptors are distinct.

If the order or the package says Menopur or menotropins, the code is S0122. For follitropin alfa billing rules, see our guide to HCPCS code S0126. The egg retrieval and embryo transfer in the same cycle are reported with the IVF procedure codes.

Diagnosis codes to pair with S0122

Every S0122 line needs an ICD-10-CM code that supports medical necessity. Payers match the diagnosis against their covered indications for menotropins, and those usually center on ART cycles.

Use the most specific N97 subcategory the record supports. Some payers accept Z31.83 alone for ART drug claims, while others require the underlying infertility diagnosis first.

Prior authorization and payer coverage for S0122

Most commercial payers manage fertility drugs closely and require prior authorization for menotropins. Published policies such as the Aetna policy on follitropins and menotropins list the criteria side by side.

Typical PA documentation:

• Infertility diagnosis with its ICD-10 code and supporting chart notes
• Ovarian reserve testing, such as AMH, antral follicle count, or day 3 FSH and estradiol
• The stimulation protocol, naming Menopur and any recombinant FSH given with it
• Planned daily dose and number of stimulation days, which the label caps at 20
• Benefit verification, including any lifetime cycle or dollar limits

A medical prior authorization form keeps these items in one request. Run insurance eligibility verification at cycle start, since many plans carve fertility drugs out to a separate administrator.

Common denial reasons for S0122 claims

S0122 denials cluster around a handful of causes, and most are visible before submission. Good denial management starts by tagging each one by root cause.

Our reference on medical billing denial codes explains the remark codes these denials come back with.

Documentation requirements for S0122

Clean S0122 claims depend on chart notes that match every field on the claim line. These are the records a payer asks for in a post-payment review.

• Physician order: names menotropins or Menopur, the daily dose in IU and the planned days
• Vials administered: the number of 75 IU vials given at each encounter, which sets the unit count
• NDC and lot number: recorded in the medication record for each package used
• Cycle monitoring notes: baseline ultrasound, estradiol levels and follicle response supporting each dose change
• Prior authorization: reference number and dates, with Menopur named on the approval
• Diagnosis support: workup notes behind the N97 or Z31 code on the claim

Keep the order, vial count and NDC in the same encounter note. A medical billing compliance checklist for fertility drugs lets the team confirm all three match before an auditor asks for them.

How Pabau helps fertility practices bill S0122 cleanly

A fertility practice running combined protocols tracks two drugs, two NDCs and two authorizations for many patients at once. When that lives in spreadsheets, a missing Menopur approval often surfaces only when the remittance arrives.

Pabau’s claims management software keeps the authorization code, dates and sessions on the patient’s case, with a warning when one is missing. US practices send CMS-1500 and 837P claims through Claim.MD, run eligibility checks and receive ERA remittances in the same system.

Stock in Pabau carries a batch number and expiry date, and the lot is recorded against the patient and the appointment. That gives the billing team the vial count and NDC for each Menopur encounter without re-keying. For a fertility practice, the chart and the claim stay in one system.

Track fertility drug authorizations and claims in one place

Pabau keeps the authorization code, dates and sessions on each patient’s case, with a warning when one is missing. See how it handles combined FSH and hMG protocols.

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Conclusion

Most S0122 problems start with a mix-up between drugs, not with the code itself. Menopur is menotropins, a urinary hMG with LH activity, and it never bills under a follitropin code.

Settle three points before the first injection. The approval names Menopur, the vial count drives the units, and each drug line carries its own NDC. A few minutes at cycle start costs far less than weeks of appeals.

Book a demo to see how Pabau keeps prior authorization details on each patient’s case for fertility billing teams.

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