HCPCS Codes for Oral Anti-Emetic Drugs (Rev. 3085, Effective: Upon Implementation of ICD-10)

by  Jared Staheli
July 8th, 2015

The physician/supplier bills for these drugs with the ASC X12 837 professional claim format, or if approved, with the paper form CMS-1500. The facility bills with the ASC X12 837 institutional claim format, or if approved, with the paper Form CMS-1450. The following HCPCS codes are assigned:

Code Description
J8501 APREPITANT, oral, 5 mg (Note: HCPCS code is effective January 1, 2005, but coverage for aprepitant is effective April 4, 2005. Aprepitant is only covered in combination with a 5HT3 antagonist, and dexamethasone for beneficiaries who have received one or more of the specified anti-cancer chemotherapeutic agents.)
Q0161 CHLORPROMAZINE HYDROCHLORIDE 5mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0163 DIPHENHYDRAMINE HYDROCHLORIDE, 50mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen.
Q0164 PROCHLORPERAZINE MALEATE, 5mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0165 PROCHLORPERAZINE MALEATE, 10mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0166 GRANISETRON HYDROCHLORIDE, 1mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 24- hour dosage regimen.
Q0167 DRONABINOL2.5mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
Q0168 RONABINO 5mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
Q0169 PROMETHAZINE HYDROCHLORIDE, 12.5mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0170 PROMETHAZINE HYDROCHLORIDE, 25mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0171 CHLORPROMAZINE HYDROCHLORIDE, 10mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0172 CHLORPROMAZINE HYDROCHLORIDE, 25mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0173 TRIMETHOBENZAMIDE HYDROCHLORIDE, 250mg, oral, FDAapproved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
Q0174 THIETHYLPERAZINE MALEATE, 10mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48- hour dosage regimen.
Q0175 PERPHENAZINE 4mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
Q0176 PERPHENAZINE, 8mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hours dosage regimen.
Q0177 HYDROXYZINE PAMOATE, 25mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
Q0178 HYDROXYZINE PAMOATE, 50mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
Q0179 ONDANSETRON mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.
Q0180 DOLASETRON MESYLATE, 100mg, oral, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 24-hour dosage regimen.
Q0181 UNSPECIFIED ORAL DOSAGE FORM, FDA-approved prescription anti-emetic, for use as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen.

NOTE: The 24-hour maximum drug supply limitation on dispensing, for HCPCS Codes Q0166 and Q0180, has been established to bring the Medicare benefit as it applies to these two therapeutic entities in conformity with the “Indications and Usage” section of currently FDA-approved product labeling for each affected drug product.

References:

HCPCS Codes for Oral Anti-Emetic Drugs (Rev. 3085, Effective: Upon Implementation of ICD-10). (2015, July 8). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/hcpcs-codes-for-oral-anti-emetic-drugs-rev-3085-effective-upon-implementation-of-icd-10-27118.html

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