S0281 — Medical home program, comprehensive care coordination and planning, maintenance of plan
S0281 is a HCPCS Level II code for medical home program, comprehensive care coordination and planning, maintenance of plan. It belongs to the Temporary National Codes (Non-Medicare) section. Medicare does not pay it — see the coverage note below before you bill it.
Medicare coverage: Not payable by Medicare
Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusI
Not valid for Medicare purposes. Medicare uses another code.
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
The CMS record for S0281
- Long descriptor
- Medical home program, comprehensive care coordination and planning, maintenance of plan
- Short descriptor
- Medical home, maintenance
- Added
- January 1, 2010
- BETOS
- Z2
- Pricing indicator
- 00 — Not priced by Part B
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Service not separately priced by Part B — not covered, bundled into another service, or used by Part A only.
Codes adjacent to S0281
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If S0281 is not quite right, the correct code is very often within a few positions of it.
- S0260History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service)
- S0265Genetic counseling, under physician supervision, each 15 minutes
- S0270Physician management of patient home care, standard monthly case rate (per 30 days)
- S0271Physician management of patient home care, hospice monthly case rate (per 30 days)
- S0272Physician management of patient home care, episodic care monthly case rate (per 30 days)
- S0273Physician visit at member's home, outside of a capitation arrangement
- S0274Nurse practitioner visit at member's home, outside of a capitation arrangement
- S0280Medical home program, comprehensive care coordination and planning, initial plan
- S0285Colonoscopy consultation performed prior to a screening colonoscopy procedure
- S0302Completed early periodic screening diagnosis and treatment (epsdt) service (list in addition to code for appropriate evaluation and management service)
- S0310Hospitalist services (list separately in addition to code for appropriate evaluation and management service)
- S0311Comprehensive management and care coordination for advanced illness, per calendar month
- S0315Disease management program; initial assessment and initiation of the program
- S0316Disease management program, follow-up/reassessment
- S0317Disease management program; per diem
- S0320Telephone calls by a registered nurse to a disease management program member for monitoring purposes; per month
Questions about S0281
What is HCPCS code S0281?
S0281 is a HCPCS Level II code for medical home program, comprehensive care coordination and planning, maintenance of plan. It sits in the Temporary National Codes (Non-Medicare) section.
Does Medicare cover S0281?
The CMS HCPCS file marks S0281 as "Not payable by Medicare". Medicare does not pay this code. It may still be valid for another payer, but a Medicare claim carrying it will not be reimbursed.
How is S0281 paid under the physician fee schedule?
S0281 carries PFS status code I. Not valid for Medicare purposes. Medicare uses another code.