Does Q0169 require prior authorization?

No, Q0169 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for Q0169?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`Q0169` — 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

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; lack of a completed SWO will result in denial.
For DMEPOS base items requiring WOPD, the supplier must have a signed WOPD prior to delivery; WOPD must list the base item and may list separately billed associated options/accessories/supplies.

Suppliers must contact the beneficiary for DMEPOS refills and document an affirmative response prior to dispensing refills; contact must occur no sooner than 30 calendar days prior to expected end of current supply.

Treating practitioners may bill only if they are enrolled as a DMEPOS supplier with the National Supplier Clearinghouse, are dispensing the drug to the beneficiary, and are authorized by the State to dispense drugs as part of their license.

Key Coverage Criteria

Coverage requires that the item meet Medicare statutory criteria (eligible benefit category and be reasonable and necessary) per Social Security Act §1862(a)(1)(A).
An FDA‑approved oral 3‑drug antiemetic regimen consisting of an oral NK‑1 antagonist plus an oral 5‑HT3 antagonist and dexamethasone (HCPCS J8540) is covered when administered to beneficiaries receiving one or more of the following chemotherapeutic agents: Alemtuzumab, Azacitidine, Bendamustine, Carboplatin, Carmustine, Cisplatin, Clofarabine, Cyclophosphamide, Cytarabine, Dacarbazine, Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Ifosfamide, Irinotecan, Lomustine, Mechlorethamine, Oxalipla [...]

`Q0169` — 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

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

Q0169 — 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

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

1 Active Policy

Related Codes

Have a follow-up question?

`Q0169` — 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