HCPCS Q0173: Oral Trimethobenzamide 250 mg as IV Anti-Emetic Substitute - OpenPayer

Summary & Overview

HCPCS Q0173: Oral Trimethobenzamide 250 mg as IV Anti-Emetic Substitute

HCPCS Level II code Q0173 identifies oral trimethobenzamide hydrochloride 250 mg as an FDA-approved prescription anti-emetic used as a complete therapeutic substitute for an intravenous anti-emetic during chemotherapy administration, limited to a 48-hour dosing regimen. Nationally, this code matters because it formalizes billing for an oral alternative to IV anti-emetics in oncology infusion settings, affecting medication administration workflows, site-of-service coding, and payer coverage determinations. Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn the clinical role of the oral anti-emetic as an IV substitute at the time of chemotherapy, typical sites of service where the code is applied, and the core billing context for this single-dose oral regimen. The publication also highlights what to expect in payer coverage patterns and coding considerations at a national level, and where policy or guideline updates could influence utilization. Data not available in the input where detailed benchmark, claim volume, or payer-specific reimbursement rates would normally be provided.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareQ0173HCPCS Level IIanti-emeticchemotherapyoral medicationoncology infusiondrug substitutiontrimethobenzamide

Billing Code Overview

HCPCS Level II code Q0173 describes trimethobenzamide hydrochloride, 250 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, with a dosing limit not to exceed a 48-hour regimen. The service type is oral prescription anti-emetic substitution for intravenous chemotherapy-related nausea control. The typical site of service is oncology infusion center or outpatient chemotherapy clinic, where this oral formulation is used in place of an IV anti-emetic during the chemotherapy encounter.

Clinical & Coding Specifications

Clinical Context

A patient receiving outpatient chemotherapy for a solid tumor or hematologic malignancy arrives at an infusion center with a history of severe nausea and vomiting related to prior intravenous anti-emetic failure or IV access limitations. The oncologist prescribes Q0173 (trimethobenzamide hydrochloride, 250 mg, oral) to be administered as a complete therapeutic substitute for an IV anti-emetic at the time of chemotherapy, not to exceed a 48-hour dosage regimen. Typical workflow: the chemotherapy nurse reviews the medication order, verifies allergies and recent anti-emetic use, administers the first oral dose prior to or at the time of chemotherapy infusion, documents administration in the infusion record, and provides the patient with instructions for any remaining doses to be taken within the 48-hour window. Documentation includes indication for substitution of oral for IV route, rationale (for example, patient venous access issues or equivalent clinical effect), dosage and timing, and monitoring for adverse effects such as sedation or extrapyramidal symptoms.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier/unspecified	Use when no specific modifier applies (billing systems may require a default code if payer allows).

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Taxonomy Code	Specialty	Notes
`207Q00000X`	Hematology-Oncology	Prescribers of chemotherapy and associated anti-emetic regimens.
`208D00000X`	Medical Oncology	Primary clinicians ordering anti-emetic substitutions for chemotherapy patients.
`363L00000X`	Infusion Therapy Specialist	Nurses and clinicians administering chemotherapy and oral anti-emetics in infusion centers.
`207R00000X`	Internal Medicine	Hospital-based or clinic physicians who may manage supportive care during chemotherapy.
`363A00000X`	Ambulatory Infusion Nurse	Providers who perform medication administration and documentation in outpatient infusion settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R11.0`	Nausea	Primary symptom indication for prescribing an anti-emetic such as `Q0173`.
`R11.2`	Nausea with vomiting, unspecified	Common presenting problem among chemotherapy patients requiring anti-emetic therapy.
`C50.912`	Malignant neoplasm of unspecified site of right female breast	Example chemotherapeutic indication where anti-emetic substitution may be needed (represents a chemotherapy population).
`C34.90`	Malignant neoplasm of unspecified part of unspecified bronchus or lung	Another cancer diagnosis commonly associated with chemotherapy and need for anti-emetic control.
`Z51.11`	Encounter for antineoplastic chemotherapy	Encounter code that justifies chemotherapy-related supportive medications such as `Q0173`.
`T88.7XXA`	Unspecified adverse effect of drug or medicament, initial encounter	Used if patient experiences adverse reaction to anti-emetic requiring modification or cessation of therapy.
`D64.9`	Anemia, unspecified	Common comorbidity in chemotherapy patients that may affect medication tolerability and clinical decisions.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Frequently billed for the concurrent IV chemotherapy session during which `Q0173` may be used as an oral anti-emetic substitute.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	May be billed when supportive injectable medications are given alongside oral anti-emetic substitution.
`36415`	Collection of venous blood by venipuncture	Commonly performed for laboratory monitoring before or during chemotherapy visits when oral anti-emetics are administered.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, moderate complexity	Used for pre-chemotherapy provider visits where anti-emetic plans, including use of `Q0173`, are discussed and documented.
`90688`	Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 13 years or older	Example of concurrent preventive care sometimes administered during outpatient oncology visits; not directly related but commonly performed during clinic encounters.

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