Q0166 HCPCS code: 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

Q0166 is the HCPCS Level II code for 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. In 2024 Medicare paid an average of $2.90 per service for Q0166 across 436 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 2 per day on DME suppliers. Medicare volume fell 40% from 2022 to 2024 (726 to 436 services). In 2024, 2 suppliers billed Medicare for Q0166 (purchases), serving 16 beneficiaries.

Code details

FieldValue
SectionQ codes — Temporary codes
Coverage codeD — Special coverage instructions apply
Pricing indicator51 — Drug or biological (priced per ASP/average sales price rules)
BETOS categoryO1D — Chemotherapy
Added1998-04-01
Last action effective2009-01-01

Who bills Q0166 (2024)

MeasureValue
Suppliers billing rentals—
Suppliers billing purchases2
Referring clinicians33
Medicare beneficiaries16
States with claims2
YearSuppliersBeneficiaries
2022231
2023423
2024216

Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.

Medicare utilization for Q0166, 2022–2024

YearServicesBeneficiariesAvg. allowedAvg. paid
202272631$1.79$1.38
202350423$4.01$3.01
202443616$3.82$2.90

States with the most Q0166 services (2024)

StateServicesAvg. paid
New York392$2.90
Georgia37$2.84

NCCI unit limits (MUE)

Claim typeMax units per dayRationale
DME suppliers2Prescribing Information
outpatient hospital claims2Prescribing Information

Medicare policy articles for this code

Covered diagnoses (1,280 ICD-10-CM codes)

The diagnoses most often listed as covered in the policy articles above:

ICD-10-CMDiagnosisArticles listing it
C00.0Malignant neoplasm of external upper lip1
C00.1Malignant neoplasm of external lower lip1
C00.3Malignant neoplasm of upper lip, inner aspect1
C00.4Malignant neoplasm of lower lip, inner aspect1
C00.6Malignant neoplasm of commissure of lip, unspecified1
C00.8Malignant neoplasm of overlapping sites of lip1
C01Malignant neoplasm of base of tongue1
C02.0Malignant neoplasm of dorsal surface of tongue1
C02.1Malignant neoplasm of border of tongue1
C02.2Malignant neoplasm of ventral surface of tongue1

Showing 10 of 1,280. The full list, non-covered diagnoses and CSV export are in Caduvo.

What changed for Q0166

Frequently asked questions

What is HCPCS code Q0166?

Q0166 is the HCPCS Level II code for 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. Short descriptor: "Granisetron hcl 1 mg oral".

How much does Medicare pay for Q0166?

In 2024, the average Medicare payment was $2.90 per service (average allowed $3.82).

Does Medicare cover Q0166?

Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.

Which diagnoses support coverage for Q0166?

Medicare policy articles that cite Q0166 list 1,280 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip), C00.3 (Malignant neoplasm of upper lip, inner aspect). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.

How many units of Q0166 can be billed per day?

2 on DME suppliers; 2 on outpatient hospital claims (NCCI medically unlikely edits).

Related Q01 codes

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Next steps

Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.

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