Q0169 HCPCS code: 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
Q0169 is the HCPCS Level II code for 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. 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 26 per day on DME suppliers.
Code details
| Field | Value |
|---|---|
| Section | Q codes — Temporary codes |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 1998-04-01 |
| Last action effective | 1998-04-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 26 | CMS Policy |
| outpatient hospital claims | 12 | Prescribing Information |
Medicare policy articles for this code
- A52480: Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics) - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
Covered diagnoses (1,280 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C01 | Malignant neoplasm of base of tongue | 1 |
| C02.0 | Malignant neoplasm of dorsal surface of tongue | 1 |
| C02.1 | Malignant neoplasm of border of tongue | 1 |
| C02.2 | Malignant neoplasm of ventral surface of tongue | 1 |
Showing 10 of 1,280. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for Q0169
- 1998-04-01: Q0169 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code Q0169?
Q0169 is the HCPCS Level II code for 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. Short descriptor: "Promethazine hcl 12.5mg oral".
Does Medicare cover Q0169?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for Q0169?
Medicare policy articles that cite Q0169 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 Q0169 can be billed per day?
26 on DME suppliers; 12 on outpatient hospital claims (NCCI medically unlikely edits).
Related Q01 codes
- Q0111 — Wet mounts, including preparations of vaginal, cervical or skin specimens
- Q0112 — All potassium hydroxide (koh) preparations
- Q0113 — Pinworm examinations
- Q0114 — Fern test
- Q0115 — Post-coital direct, qualitative examinations of vaginal or cervical mucous
- Q0138 — Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-esrd use)
- Q0139 — Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for esrd on dialysis)
- Q0144 — Azithromycin dihydrate, oral, capsules/powder, 1 gram
- Q0155 — Dronabinol (syndros), 0.1 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 48 hour dosage regimen
- Q0161 — Chlorpromazine hydrochloride, 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
- Q0162 — Ondansetron 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 48 hour dosage regimen
- 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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under Q0169
- Watch Q0169 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for Q0169
Sources: CMS HCPCS Level II release October 2025; 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.