Summary & Overview
HCPCS Q0167: Dronabinol 2.5 mg Oral Anti-emetic for Chemotherapy Substitute
HCPCS Level II code Q0167 designates dronabinol 2.5 mg oral as an FDA-approved anti-emetic used specifically as a complete therapeutic substitute for an IV anti-emetic during chemotherapy, with dosing limited to a 48-hour regimen. This code matters nationally as it defines coverage and billing for an oral alternative at the point of chemotherapy administration, affecting oncology clinics, infusion centers, and outpatient oncology workflows.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context, common billing practices, and payer coverage considerations relevant to this code. The publication summarizes typical sites of service and service type, highlights common modifiers used with HCPCS Level II drug coding, and provides guidance on where to look for payer-specific policy details.
The report covers benchmarks and policy updates affecting billing for oral anti-emetic substitution at the time of chemotherapy, explains how HCPCS Level II code Q0167 is applied in practice, and outlines implications for claims submission workflows and service line alignment. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code Q0167 represents dronabinol, 2.5 mg, oral, an FDA-approved prescription anti-emetic intended as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy treatment, limited to a 48-hour dosage regimen. The service is pharmacologic anti-emetic therapy administered to manage chemotherapy-induced nausea and vomiting when an oral substitute is used in lieu of an IV agent.
-
Service type: Oral prescription anti-emetic substitution for IV chemotherapy anti-emetic
-
Typical site of service: Oncology clinic or infusion center at the time of chemotherapy treatment; may also be administered in an outpatient setting associated with chemotherapy visits
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult oncology patient receiving moderately or highly emetogenic chemotherapy who cannot, or prefers not to, receive an IV anti-emetic at the time of infusion. The patient presents to an outpatient oncology infusion center or clinic on the day of chemotherapy. After assessment by the oncology nurse and review of the chemotherapy regimen and anti-emetic plan, the provider prescribes Q0167 (dronabinol, 2.5 mg, oral) as a complete therapeutic substitute for the IV anti-emetic for up to a 48‑hour regimen. The nursing workflow includes medication reconciliation, verification of the prescription, documentation in the infusion record, and patient education on dosing, onset of action, and potential adverse effects (e.g., dizziness, sedation, dysphoria). The oral dronabinol is administered per prescription either in clinic prior to chemotherapy or dispensed to the patient for use at home within the 48‑hour window. Documentation elements include diagnosis linking to chemotherapy-induced nausea and vomiting, indication for oral substitution for IV anti-emetic, dosage and administration times, informed consent/education, and any observed adverse reactions during the observation period. Typical sites of service are outpatient infusion centers, oncology clinics, and hospital outpatient departments; occasional use may occur in emergency departments when IV access is deferred and oral therapy is clinically appropriate.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |