S9986 Not medically necessary service
Also known as: not medically necessary service, uncovered service, non-covered services
Services determined not medically necessary or not covered by insurance and rendered to patient who is aware of lack of coverage.
In Plain Language
uncovered medical service; not covered treatment
Clinical Context
Administrative code for services provided that are not deemed medically necessary or covered by the patient's insurance plan.
RVU Information
CPT S9986 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 S9986?
CPT S9986 (Not medically necessary service) is a S Codes code. Services determined not medically necessary or not covered by insurance and rendered to patient who is aware of lack of coverage.
Is S9986 covered by insurance?
S9986 is a temporary HCPCS code. Coverage varies by payer and may change when permanent codes are assigned. Administrative code for services provided that are not deemed medically necessary or covered by the patient's insurance plan.
When is CPT S9986 used?
Administrative code for services provided that are not deemed medically necessary or covered by the patient's insurance 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.