State-Specific Services codes S0190 to S0215 with Medicaid rates by state

4 state-specific services codes from S0190 to S0215 carry a published Medicaid rate in ten or more states. The median shown is across those states' unmodified published rates; open a code for the full state-by-state table with percent of Medicare and prior-authorization flags.

CodeDescriptionStatesMedian rate
S0190Mifepristone, oral, 200 mg17$67.67
S0191Misoprostol, oral, 200 mcg16$0.97
S0199Medically induced abortion by oral ingestion of medication including all associated services and supplies (e.g., patient counseling, office visits, confirmation of pregnancy by hcg, ultrasound to confirm duration of pregnancy, ultrasound to confirm completion of abortion) except drugs17$424.51
S0215Non-emergency transportation; mileage, per mile23$1.39

Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.