2024 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

Short Description	Hydroxyzine pamoate 25mg
HCPCS Coverage Code	D - Special coverage instructions apply
HCPCS Action Code	N - No maintenance for this code
HCPCS Action Effective Date	April 01, 1998
HCPCS Code Added Date	April 01, 1998
HCPCS Pricing Indicator Code	51 - Drugs
HCPCS Multiple Pricing Indicator Code	A - Not applicable as HCPCS priced under one methodology
HCPCS Coverage Issues Manual Reference Section Number
HCPCS Type Of Service Code	1 - Medical care
HCPCS Anesthesia Base Unit Quantity	0