HCPCS code S0162: Deleted efalizumab injection code

HCPCS code S0162 is a deleted Level II code for injection, efalizumab, 125 mg, the psoriasis biologic sold as Raptiva. The code was deleted on September 30, 2009, a few months after Raptiva left the US market. It no longer appears in the CMS HCPCS files, so a claim carrying S0162 today will be rejected.

If you arrived here looking for Depo-Provera billing, S0162 is the wrong code. Medroxyprogesterone acetate is billed with HCPCS code J1050, which is reported per 1 mg. A standard 150 mg Depo-Provera injection is 150 units of J1050, with the NDC on the claim and CPT 96372 for the injection itself.

Key takeaways

HCPCS code S0162 described injection, efalizumab, 125 mg, a psoriasis biologic sold as Raptiva, and it was deleted on September 30, 2009.

S0162 is absent from the current CMS HCPCS files and was never reassigned, so a claim carrying it today rejects as an invalid code.

Depo-Provera is billed with J1050 at one unit per 1 mg, so a 150 mg injection is reported as 150 units.

Every J1050 claim needs the 11-digit NDC with the N4 qualifier, plus CPT 96372 for the injection.

Chargemasters, superbills and order sets that still list S0162 need cleaning up, so the code never reaches a payer.

HCPCS code S0162: Official descriptor and status

The official descriptor for HCPCS code S0162 is “Injection, efalizumab, 125 mg.” It sat in the S-code series of HCPCS Level II codes. S-codes are temporary national codes that private insurers and Medicaid programs use where no permanent code exists. Medicare does not pay S-codes. S0162 was deleted on September 30, 2009, and CMS never reassigned the number to another drug.

The code is absent from the CMS alpha-numeric HCPCS files for January 2025 and October 2026. In that stretch of the series, the files list S0160, S0164, S0166 and S0169, with no S0162 between them. You can check any quarter yourself in the CMS HCPCS quarterly update files.

What efalizumab was and why S0162 was retired

Efalizumab was a once-weekly injection for adults with moderate to severe plaque psoriasis. The FDA approved it in 2003, and Genentech sold it in the US as Raptiva.

In April 2009, Genentech began a voluntary, phased withdrawal of Raptiva from the US market. The reason was a risk of progressive multifocal leukoencephalopathy (PML), a rare brain infection that is usually fatal. Raptiva was no longer available in the United States after June 8, 2009.

With the drug gone, the code had nothing left to describe. S0162 was deleted on September 30, 2009, less than four months after the last US supply was withdrawn.

Can you still bill HCPCS code S0162?

No, S0162 cannot be billed today. A deleted HCPCS code is invalid for any date of service after its deletion date, so a claim line carrying S0162 will be rejected. Payers typically return it with claim adjustment reason code 181, “Procedure code was invalid on the date of service.”

Dates of service up to September 30, 2009 could be billed with S0162 at the time. Those claims are now far outside any timely filing limit, which payers usually set at 90 days to one year from the date of service. In practice, S0162 now turns up in old records and outdated code lists rather than in new claims.

Why an ICD-10 code next to S0162 signals a data error

S0162 and ICD-10-CM were never in use at the same time. ICD-10-CM took effect on October 1, 2015, six years after S0162 was deleted. A genuine S0162 claim therefore carried an ICD-9-CM diagnosis, such as 696.1 for psoriasis. The timeline below shows how far apart the two code sets sit.

An S0162 line paired with an ICD-10-CM code, such as L40.0 for psoriasis vulgaris or a Z30 contraceptive code, cannot be a 2009 efalizumab claim. It points to a data migration error or a charge mapped to the wrong code. Check whether the charge was a medroxyprogesterone injection that belongs under J1050.

Billing Depo-Provera: Use J1050, not S0162

The current code for medroxyprogesterone acetate is J1050, “Injection, medroxyprogesterone acetate, 1 mg.” Each billing unit is 1 mg, so the unit count follows the dose. A 150 mg intramuscular Depo-Provera injection is 150 units, and a Depo-SubQ Provera 104 dose is 104 units.

J1051 and J1055, the older medroxyprogesterone codes, were discontinued on December 31, 2012. Neither is valid for a current date of service, which leaves J1050 as the code to use.

A clean J1050 claim for a contraceptive injection carries five elements:

1. Drug code and units: J1050, with units equal to the milligrams given, which is 150 for a standard Depo-Provera dose.
2. NDC: The N4 qualifier followed by the 11-digit NDC of the package used, such as N400009074630 for a Depo-Provera 150 mg/mL vial.
3. Administration: CPT 96372 for the intramuscular or subcutaneous injection, billed as its own line.
4. Diagnosis: Z30.013 for the first prescription of an injectable contraceptive, or Z30.42 for a repeat injection in an ongoing regimen.
5. Payer modifiers: Some state Medicaid programs ask for a family planning modifier, such as FP, so check the state billing manual.

The NDC on the claim has to match the product you opened. The table below lists the current Depo-Provera packages in the FDA NDC Directory, converted to the 11-digit format claims use.

On the claim, the NDC goes without hyphens after the N4 qualifier. The prefilled syringe, for example, is reported as N400009737611.

How to clean S0162 out of your billing setup

A deleted code that stays in a fee schedule keeps reaching claims. Work through these steps once, then repeat the check with each quarterly HCPCS update.

1. Search the chargemaster, fee schedules, superbill templates and EHR order sets for S0162.
2. Check what each entry was meant to bill before you change it.
3. Remap any medroxyprogesterone entry to J1050, with units per milligram and an NDC field.
4. Deactivate any efalizumab entry, since there is no current product to bill.
5. Leave historical claims and remittances as they were billed, and add a note where a record needs context.
6. Compare the code list against the CMS quarterly HCPCS file every quarter.

Common claim errors linked to S0162

Most errors around S0162 come from treating it as a Depo-Provera code. The table below maps each one to what the payer does and the fix.

A clean claim review that checks each code against the date of service catches the first and third errors before submission. For patterns that keep coming back, denial management tracking shows which payer and which code line they come from.

How Pabau keeps retired codes off your claims

A deleted code usually survives in a fee schedule nobody has opened since it was built. The billing team picks it from a list, the payer rejects it, and the rework lands weeks later.

Pabau’s billing tools hold the practice’s code list and send US claims electronically through Claim.MD. Its claims management software covers eligibility checks and ERA remittances too. Rejections come back to the same system that built the claim, so a dead code is fixed once at the source.

For an injectable such as Depo-Provera, the practice records the batch number and expiry date against the patient and the appointment. The billing team then has the product detail it needs to match the NDC on the claim.

Bill injectables with current codes

Pabau keeps your billing codes, patient records and US claims through Claim.MD in one system. An injectable claim goes out with a valid code and the product detail recorded at the visit.

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Conclusion

S0162 is a closed chapter. It described a drug that left the US market in 2009, and the code went with it. The work it creates now is housekeeping: Finding the code wherever it survives and deciding what each entry was meant to bill.

For medroxyprogesterone, the decision is already made. Payers expect J1050 at one unit per milligram, the NDC of the package used, and CPT 96372 for the injection. The trade-off to remember is units, because a remapped line left at 1 unit underbills the dose.

Book a demo to see how Pabau keeps injectable billing codes current, from the patient record to the claim.

Continue your research

Need a full picture of your denial patterns? Denial management in healthcare covers how to categorize, track, and appeal claim denials systematically across your payer mix.

Looking for broader billing compliance guidance? Medical billing compliance outlines the documentation and audit-readiness standards that apply to drug claims across payer types.

Billing the Depo-Provera dose itself? HCPCS code J1050 is our billing guide for medroxyprogesterone acetate injections.

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