S0274 Nurse practr visit outs cap
Also known as: NP visit, nurse practitioner home visit
Nurse practitioner visit outside fee schedule cap. House call or office evaluation by nurse practitioner beyond capitated care limits.
In Plain Language
nurse visit; provider home call
Clinical Context
Nurse practitioner provides comprehensive evaluation and management at home or office setting for patients managed under shared care or when physician unavailable. Documents assessment and plan.
RVU Information
CPT S0274 does not have a physician work RVU assigned by CMS. This is typical for supply, drug, and equipment codes — reimbursement is based on Average Sales Price (ASP), fee schedules, or payer contracts rather than the RVU system.
Billing & Documentation
S-codes are used by private payers (not Medicare) for services without a standard CPT or HCPCS code. Coverage varies significantly between insurers. Verify payer acceptance before billing and document medical necessity thoroughly.
Specialties
Frequently Asked Questions
What is CPT code S0274?
CPT S0274 (Nurse practr visit outs cap) is a S Codes code. Nurse practitioner visit outside fee schedule cap. House call or office evaluation by nurse practitioner beyond capitated care limits.
Is S0274 covered by insurance?
S0274 is a temporary HCPCS code. Coverage varies by payer and may change when permanent codes are assigned. Nurse practitioner provides comprehensive evaluation and management at home or office setting for patients managed under shared care or when physician unavailable. Documents assessment and plan.
When is CPT S0274 used?
Nurse practitioner provides comprehensive evaluation and management at home or office setting for patients managed under shared care or when physician unavailable. Documents assessment and plan.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.