Q0175 HCPCS - 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

Code Information

HCPCS Code: Q0175

Sequence Number: 0010

Short Description: Perphenazine 4mg oral

Long Description: 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

Code Added Date: 4/1/1998

Action Code: N - No maintenance for this code

Action Effective Date: 4/1/1998

Classification: Temporary Codes

Coding System: HCPCS

Code Type

Berenson-Eggers Type Of Service Code: O1D - Chemotherapy
Type Of Service Code:
  • 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96

Billing Information

Pricing Indicator Code:
  • 51 - Drugs
Multiple Pricing Indicator Code: A - Not applicable as HCPCS priced under one methodology
Coverage Issues Manual Reference Section Number:
    N/A
    Medicare Carriers Manual Reference Section Number:
      N/A
      Coverage Code: D - Special coverage instructions apply

      HCPCS Record

      Field Name Field Value
      Healthcare Common Procedure Coding System Code Q0175
      HCPCS Sequence Number 0010
      HCPCS Record Identification Code 3 - First line of procedure record also contains detail information in positions 92-275
      HCPCS Long Description 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 Short Description Perphenazine 4mg oral
      HCPCS Pricing Indicator Code 1 51 - Drugs
      HCPCS Multiple Pricing Indicator Code A - Not applicable as HCPCS priced under one methodology
      HCPCS Statute Number 4557
      HCPCS Coverage Code D - Special coverage instructions apply
      HCPCS Berenson-Eggers Type Of Service Code O1D - Chemotherapy
      HCPCS Type Of Service Code 1 1 - Whole blood only eff 01/96, whole blood or packed red cells before 01/96
      HCPCS Anesthesia Base Unit Quantity 0
      HCPCS Code Added Date 4/1/1998
      HCPCS Action Effective Date 4/1/1998
      HCPCS Action Code N - No maintenance for this code

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      This page was last updated on: 1/1/2018