Field Name |
Field Value |
Healthcare Common Procedure Coding System Code |
Q0177 |
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 |
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 |
HCPCS Short Description |
Hydroxyzine pamoate 25mg |
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 |