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HCPCS Q0177

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

Table of Contents

  1. HCPCS Information
  2. HCPCS Crossover to NDC Codes

HCPCS Information

HCPCS Code: Q0177
The Healthcare Common Procedure Coding System (HCPCS) is a set of unique alphanumeric codes used to report medical procedures and services to healthcare programs like Medicare and Medicaid. HCPCS codes are used in conjunction with NDC codes for billing and medical documentation puporses. For instance, HCPCS Q0177 identifies the type of service or supply used while any of the 41 NDC codes below could be used to specify the exact drug used.
Short Description
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
Pricing Indicator
Drugs
Multiple Pricing Indicator
Not applicable as HCPCS priced under one methodology
Coverage Description
Special coverage instructions apply
BETOS Type of Service
Chemotherapy
HCPCS Classification
List of HCPCS codes for: Temporary Codes (Q-codes)

HCPCS Crossover to NDC Codes

The NDC codes below allow precise billing based on the specific manufacturer and medication used:

NDC Proprietary Name Non-Proprietary Name Dosage Form Route Name Company Name Status
0069-5410Vistaril Hydroxyzine PamoateCapsuleOralPfizer Laboratories Div Pfizer IncACTIVE
0069-5420Vistaril Pfizer Laboratories Div Pfizer Inc
0115-1803Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralAmneal Pharmaceuticals Of New York LlcACTIVE
0115-1804Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralAmneal Pharmaceuticals Of New York LlcACTIVE
0185-0615Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralSandoz IncACTIVE
0185-0676Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralSandoz IncACTIVE
0555-0302Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralTeva Pharmaceuticals Usa, Inc.ACTIVE
0555-0323Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralTeva Pharmaceuticals Usa, Inc.ACTIVE
0555-0324Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralTeva Pharmaceuticals Usa, Inc.ACTIVE
0591-0800Hydroxyzine Pamoate Actavis Pharma, Inc.
0591-0801Hydroxyzine Pamoate Actavis Pharma, Inc.
0904-6617Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTablet, Film CoatedOralMajor PharmaceuticalsACTIVE
0904-7065Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralMajor PharmaceuticalsACTIVE
0904-7378Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTabletOralMajor PharmaceuticalsACTIVE
10135-811Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTablet, Film CoatedOralMarlex Pharmaceuticals, Inc.ACTIVE
11534-205Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTablet, Film CoatedOralSunrise Pharmaceutical, Inc.ACTIVE
14539-674Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralHeritage Pharmaceuticals Inc. D/b/a Avet Pharmaceuticals Inc.ACTIVE
14539-675Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralHeritage Pharmaceuticals Inc. D/b/a Avet Pharmaceuticals Inc.ACTIVE
16571-114Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTablet, Film CoatedOralRising Pharma Holdings, Inc.ACTIVE
42291-406Hydroxyzine Pamoate Avkare
42291-407Hydroxyzine Pamoate Avkare
49452-3659 Hydroxyzine PamoatePowderSpectrum Laboratory Products, Inc.ACTIVE
50268-398Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralAvpakACTIVE
50268-399Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralAvpakACTIVE
51079-077Hydroxyzine Pamoate Mylan Institutional Inc.
51079-078Hydroxyzine Pamoate Mylan Institutional Inc.
51927-2316 Hydroxyzine PamoatePowderProfessional Compounding Centers Of America Dba PccaACTIVE
52959-433Hydroxyzine Pamoate H.j. Harkins Company, Inc.INACTIVATED
54569-2353Hydroxyzine Pamoate A-s Medication Solutions Llc
54569-2571Hydroxyzine Pamoate A-s Medication SolutionsINACTIVATED
54868-2892Hydroxyzine Pamoate Physicians Total Care, Inc.INACTIVATED
55289-226Hydroxyzine Pamoate Pd-rx Pharmaceuticals, Inc.
55289-354Hydroxyzine Pamoate Pd-rx Pharmaceuticals, Inc.
59651-500Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTablet, Film CoatedOralAurobindo Pharma LimitedACTIVE
59651-500 Hydroxyzine HydrochlorideTablet, Film CoatedAurobindo Pharma LimitedACTIVE
59762-5420Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralMylan Pharmaceuticals Inc.ACTIVE
62135-574Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTabletOralChartwell Rx, LlcACTIVE
62135-816Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralChartwell Rx, LlcACTIVE
62135-817Hydroxyzine Pamoate Hydroxyzine PamoateCapsuleOralChartwell Rx, LlcACTIVE
63629-1533Hydroxyzine Pamoate Bryant Ranch Prepack
63629-1856Hydroxyzine Hydrochloride Hydroxyzine HydrochlorideTablet, Film CoatedOralBryant Ranch PrepackACTIVE