FOLLISTIM AQ S Code: S0128

Drug & Product Overview

HCPCS Descriptor Injection, follitropin beta, 75 iu

HCPCS Added Date April 1, 2002

Manufacturer Merck

Route of Administration Subcutaneous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Solution

About FOLLISTIM AQ

Follistim AQ is a medication aligned to the HCPCS S Code: S0128 for billing, pricing, and reimbursement purposes in the United States. Classified under Fertility, it is administered via the subcutaneous route and manufactured by Merck.

Manufacturers, reach out to us to add more information.

NDC Code Information

1 NDC package is crosswalked to S0128. Package detail is available to logged-in subscribers.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
•••••-••••-•• Log in to view	FOLLISTIM AQ

Login to view 1 NDC package View pricing, complete NDC-to-HCPCS alignments, and package details.

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FOLLISTIM AQ Pricing & Reimbursement

S0128 Private Payer Reimbursement

$218.21 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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FOLLISTIM AQ CPT Administration Codes

CPT Code	Description
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intramuscular

Not on the CMS JW / JZ list

CMS does not include Follistim AQ (S0128) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing S0128. Wastage billing guide →

FOLLISTIM AQ Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

Induction of Ovulation and Pregnancy in Anovulatory Infertile Women in Whom the Cause of Infertility is Functional and Not Due to Primary Ovarian Failure Pregnancy in Normal Ovulatory Women Undergoing Controlled Ovarian Stimulation as Part of an In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) Cycle Induction of Spermatogenesis in Men with Primary and Secondary Hypogonadotropic Hypogonadism (HH) in Whom the Cause of Infertility is Not Due to Primary Testicular Failure

Drug Class

Gonadotropin [EPC]Gonadotropins [CS]

Frequently Asked Questions

Is there an available Follistim Aq billing and coding guide?

Our team has not identified a manufacturer-published source of billing and coding information for FOLLISTIM AQ.

Are there any available Follistim Aq patient assistance programs?

FOLLISTIM AQ patient assistance information can be found through Merck. Visit Here →

Where can I find Follistim Aq prescribing information?

FOLLISTIM AQ prescribing information can be found at the link below: Visit Here →

Where can I find Follistim Aq side effect information?

Our team has not yet identified a source of side effects information for FOLLISTIM AQ. Please check back in a few weeks.

Does billing FOLLISTIM AQ require JZ/JW wastage modifiers?

CMS does not include FOLLISTIM AQ (S0128) on its list of HCPCS pertaining to single-dose containers. Per CMS guidelines, the JZ/JW wastage modifiers may not apply when billing S0128. For more information, visit the link below.

About BuyandBill.com:

The BuyandBill.com team is dedicated to delivering high-quality coding and billing information for office-administered drugs. We continuously research HCPCS-coded medications to expand our resources and ensure data accuracy. Manufacturers: click here to sponsor your medication, and we will ensure the most accurate and detailed information is displayed.