HCPCS Level IItemporaryActive
Q0177
Hydroxyzine pamoate 25mg
BETOS: O1D
Effective: 1998-04-01
Referenced in 1 policies
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
Drug Products
FDA-registered drug products mapped to this HCPCS code
Vistaril25
hydroxyzine pamoate
NDC: 00069-5410-66CAPSULE