Showing codes Q0163 (Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen) — Q0478 (Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type)

Q0163 - Diphenhydramine hcl 50mg
Long description: Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen
Code added date: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0164 - Prochlorperazine maleate 5mg
Long description: Prochlorperazine maleate, 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
Code added date: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0165 - Prochlorperazine maleate10mg
Long description: Prochlorperazine maleate, 10 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: 19980401.
Code effective date: 20140101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0166 - Granisetron hcl 1 mg oral
Long description: Granisetron hydrochloride, 1 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
Code added date: 19980401.
Code effective date: 20090101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0167 - Dronabinol 2.5mg oral
Long description: Dronabinol, 2.5 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
Code added date: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0168 - Dronabinol 5mg oral
Long description: 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
Code added date: 19980401.
Code effective date: 20140101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0169 - Promethazine hcl 12.5mg oral
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
Code added date: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0170 - Promethazine hcl 25 mg oral
Long description: 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
Code added date: 19980401.
Code effective date: 20140101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0171 - Chlorpromazine hcl 10mg oral
Long description: Chlorpromazine hydrochloride, 10 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: 19980401.
Code effective date: 20140101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0172 - Chlorpromazine hcl 25mg oral
Long description: Chlorpromazine 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
Code added date: 19980401.
Code effective date: 20140101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0173 - Trimethobenzamide hcl 250mg
Long description: Trimethobenzamide hydrochloride, 250 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: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0174 - Thiethylperazine maleate10mg
Long description: Thiethylperazine maleate, 10 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: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0175 - 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: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0176 - Perphenazine 8mg oral
Long description: Perphenazine, 8mg, 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: 19980401.
Code effective date: 20140101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0177 - Hydroxyzine pamoate 25mg
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
Code added date: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0178 - Hydroxyzine pamoate 50mg
Long description: Hydroxyzine pamoate, 50 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: 19980401.
Code effective date: 20140101.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0180 - Dolasetron mesylate oral
Long description: 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
Code added date: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0181 - Unspecified oral anti-emetic
Long description: Unspecified oral dosage form, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for a iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen
Code added date: 19980401.
Code effective date: 19980401.
Pricing Indicator Code(s): 51 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0220 - Tixagev and cilgav, 300mg
Long description: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg
Code added date: 20211208.
Code effective date: 20211208.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0221 - Tixagev and cilgav, 600mg
Long description: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg
Code added date: 20220224.
Code effective date: 20220224.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0222 - Bebtelovimab 175 mg
Long description: Injection, bebtelovimab, 175 mg
Code added date: 20220211.
Code effective date: 20220211.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0224 - Inj, pemivibart, 4500 mg
Long description: Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to covid-19 vaccination, 4500 mg
Code added date: 20240322.
Code effective date: 20240322.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0239 - Bamlanivimab-xxxx
Long description: Injection, bamlanivimab-xxxx, 700 mg
Code added date: 20201109.
Code effective date: 20210417.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0240 - Casirivi and imdevi 600 mg
Long description: Injection, casirivimab and imdevimab, 600 mg
Code added date: 20210730.
Code effective date: 20210730.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0243 - Casirivimab and imdevimab
Long description: Injection, casirivimab and imdevimab, 2400 mg
Code added date: 20201121.
Code effective date: 20201121.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0244 - Casirivi and imdevi 1200 mg
Long description: Injection, casirivimab and imdevimab, 1200 mg
Code added date: 20210603.
Code effective date: 20210603.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0245 - Bamlanivimab and etesevima
Long description: Injection, bamlanivimab and etesevimab, 2100 mg
Code added date: 20210209.
Code effective date: 20210209.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0247 - Sotrovimab
Long description: Injection, sotrovimab, 500 mg
Code added date: 20210526.
Code effective date: 20210526.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0249 - Tocilizumab for covid-19
Long description: Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg
Code added date: 20210624.
Code effective date: 20210624.
Pricing Indicator Code(s): 54 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: C (A code denoting Medicare coverage status).
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Q0477 - Pwr module pt cable lvad rpl
Long description: Power module patient cable for use with electric or electric/pneumatic ventricular assist device, replacement only
Code added date: 20180101.
Code effective date: 20180101.
Pricing Indicator Code(s): 38 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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Q0478 - Power adapter, combo vad
Long description: Power adapter for use with electric or electric/pneumatic ventricular assist device, vehicle type
Code added date: 20110101.
Code effective date: 20130101.
Pricing Indicator Code(s): 38 ; (Codes used to identify the appropriate methodology for developing unique pricing amounts under part B. A procedure may have one to four pricing codes.)
Coverage Code: D (A code denoting Medicare coverage status).
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