HCPCS Code Details - Q0169

2017 HCPCS Level II Code
Miscellaneous Services (Temporary Codes)
HCPCS Code Q0169
Description

Long description:
Promethazine hydrochloride, 12.5 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

Short description:
Promethazine hcl 12.5mg oral

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Statute number 4557
Coverage code D - Special coverage instructions apply
BETOS2 code O1D - Chemotherapy
HCPCS Action code N - No maintenance for this code
Type of service 1 - Medical care
Effective date Effective Apr 01, 1998
Date added Apr 01, 1998
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - Q0169

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
July 1, 2017 - September 30, 2017 12.5 MG 0.042 - - - - - -
April 1, 2017 - June 30, 2017 12.5 MG 0.032 - - - - - -
January 1, 2017 - March 31, 2017 12.5 MG 0.017 - - - - - -
October 1, 2016 - December 31, 2016 12.5 MG 0.021 - - - - - -
July 1, 2016 - September 30, 2016 12.5 MG 0.028 - - - - - -
12.5 MG 0.035 - - - - - -
12.5 MG 0.031 - - - - - -

See also

  • HCPCS Q0168 · Dronabinol, 5 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

  • HCPCS Q0170 · Promethazine hydrochloride, 25 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


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”