HCPCS Code Q0177

Hydroxyzine pamoate, 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
Code effective Apr 01, 1998

HCPCS Section
Miscellaneous Services (Temporary Codes)

Q0177 is a valid 2026 HCPCS code meaning Hydroxyzine pamoate, 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 or (Hydroxyzine pamoate 25mg) for short. HCPCS Q0177 has been effective since 04/01/1998 and applies to Medical care.

HCPCS Code Details - Q0177

HCPCS Level II Code
Section Q - Miscellaneous Services (Temporary Codes)
HCPCS Code Q0177
Description

Long description:
Hydroxyzine pamoate, 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

Short description:
Hydroxyzine pamoate 25mg

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 Added Apr 01, 1998

See also

  • HCPCS Q0175 · Perphenazine, 4 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 Q0180 · Dolasetron mesylate, 100 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 24 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”

HCPCS Level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). — Updated 6/23/2026

CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved.