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HCPCS Q0177 Fee Schedule

Last Verified: December 2025

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

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
Key FactDetail
Service Type

Temporary Codes

Chemotherapy Anti-emetic Medications

Complexity LevelLow
Related NDC Codes

00069-5410-66 - VISTARIL 25 MG

00069-5420-66 - VISTARIL 50 MG

00115-1803-01 - HYDROXYZINE PAMOATE 25 MG

00115-1803-02 - HYDROXYZINE PAMOATE 25 MG

00115-1804-02 - HYDROXYZINE PAMOATE 50 MG


National average reimbursement for HCPCS Q0177 by major payers:

bcbs

$0.18

uhc

$0.11

aetna

$0.15

cigna

$0.22

Preview provider-level rates for...
For billing codeHCPCS Q0177
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for HCPCS Q0177

United
Q0177$0.211073502985 - CHU CHEN42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC.MAPediatrics Physician (208000000X)
United
Q0177$0.101790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
Q0177$0.101790057420 - BAMA HEART DOC, P.C., ALABAMA HEART AND VASCULAR MEDICINE451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
Q0177$0.101851400485 - GEORGE HEMSTREET451471722 - (AL) BAMA HEART DOC, PC DBA ALABAMA HEART & VASCULAR MEDICINEALInterventional Cardiology Physician (207RI0011X)
United
Q0177$0.101194489104 - IRENE ALFORD843505937 - (TX) ATTIGO INFUSION INCTXFamily Nurse Practitioner (363LF0000X)
United
Q0177$0.101891339644 - ATTIGO INFUSION INC, MEDIX INFUSION843505937 - (TX) ATTIGO INFUSION INCTXInfectious Disease Physician (207RI0200X)
United
Q0177$0.171073502985 - CHU CHEN42484572MAPediatrics Physician (208000000X)
United
Q0177$0.071578866737 - CORAM ALTERNATE SITE SERVICES INC760215922FLHome Infusion Therapy Pharmacy (3336H0001X)
United
Q0177$0.101902957541 - WILDWOOD SANITARIUM INCORPORATED, WILDWOOD MEDICAL CLINIC586039864 - (GA) WILDWOOD SANITARIUM INCORPORATEDGAGeneral Acute Care Hospital (282N00000X)
United
Q0177$0.101548859895 - ALICIA ENCINAS300394179 - (AZ) MIGUEL A ARENAS MD PCCAFamily Nurse Practitioner (363LF0000X)
United
Q0177$0.101710561360 - IRENE VERA843505937 - (TX) ATTIGO INFUSION INCTXNurse Practitioner (363L00000X)
United
Q0177$0.101740272095 - DODGE COUNTY HOSPITAL AUTHORITY, DODGE COUNTY HOSPITAL580625140 - (GA) DODGE COUNTY HOSPITAL AUTHORITYGARural Acute Care Hospital (282NR1301X)
United
Q0177$0.101225339898 - SCREVEN COUNTY HOSPITAL, LLC, OPTIM MEDICAL CENTER - SCREVEN273100946GACritical Access Hospital (282NC0060X)
United
Q0177$0.101316938459 - NAVICENT HEALTH OCONEE, LLC, NAVICENT HEALTH BALDWIN582359398 - NAVICENT HEALTH OCONEE LLCGAGeneral Acute Care Hospital (282N00000X)
United
Q0177$0.101255891958 - PIEDMONT NEWTON EKG BILLING LLC582155150 - (GA) PIEDMONT NEWTON HOSPITAL INCGAGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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HCPCS Q0177 vs. Other Chemotherapy Anti-emetic Medications Codes

The HCPCS Q0177 code is part of the Temporary Codes services used for Chemotherapy Anti-emetic Medications. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The HCPCS Q0177 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
00069-5410-66-NDCModerateVISTARIL 25 MG
00069-5420-66-NDCModerateVISTARIL 50 MG
00115-1803-01-NDCModerateHYDROXYZINE PAMOATE 25 MG
Q0177-HCPCSLowHydroxyzine 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

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS Q0177. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the Q0177 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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