Summary & Overview
HCPCS S0175: Flutamide, Oral, 125 mg
HCPCS Level II code S0175 identifies flutamide, oral, 125 mg, an antiandrogen medication used in oncologic and endocrine care. Nationally, accurate reporting of drug-specific HCPCS codes like S0175 is important for drug inventory management, outpatient billing, prior authorization workflows, and monitoring utilization of oral oncology therapies. This publication examines payer coverage patterns and coding practices relevant to S0175 and situates the code within clinical and administrative workflows.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise set of benchmarks and policy considerations relevant to reimbursement coding, common billing modifiers, and typical sites of service for an oral antineoplastic agent. The piece also outlines clinical context for flutamide as an oral antiandrogen and describes where and how the code is typically used in outpatient and ambulatory care settings.
The report is intended for coding professionals, revenue cycle managers, pharmacy directors, and clinicians involved in prescribing or billing for oral cancer therapies. It provides actionable reference material on billing code usage, payer coverage landscape, and administrative details necessary to support consistent claim submission and interpretation.
Billing Code Overview
HCPCS Level II code S0175 represents Flutamide, oral, 125 mg. This code denotes a prescription drug product administered orally and is classified under HCPCS Level II for reporting drugs and biologicals supplied in outpatient and physician office settings.
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Service type: Oral medication (antiandrogen therapy)
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Typical site of service: Outpatient clinic, physician office, or other ambulatory settings where oral oncology therapies are prescribed and dispensed
Data not available in the input regarding associated taxonomies, specific ICD-10 diagnoses, related codes, or service line.
Clinical & Coding Specifications
Clinical Context
A male patient with metastatic prostate cancer is prescribed oral anti-androgen therapy with S0175 (flutamide, oral, 125 mg) as part of systemic hormone therapy. Typical workflow: the oncology or urology clinic documents the indication and obtains baseline labs (liver function tests, PSA), reviews contraindications and prior therapies, writes the prescription, and establishes monitoring intervals. Pharmacy dispenses S0175 with patient counseling on dosing (commonly three times daily), potential hepatotoxicity, gastrointestinal side effects, and the need to report jaundice or dark urine. Follow-up visits with the prescribing oncologist or urologist assess treatment response via PSA, clinical symptoms, and periodic liver function monitoring. Supportive services (infusion center scheduling is not applicable because this is oral therapy) include medication assistance programs and coordination with specialty pharmacies for coverage and prior authorization when required.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service or procedure code not used | Rarely used; not typically applied to oral drug HCPCS billing |
22 | Increased procedural services | Use when work required is substantially greater than usual (e.g., extensive medication management for complex comorbidity) |
23 | Unusual anesthesia | Not applicable to an oral medication but may appear if reported alongside a procedure requiring undocumented anesthesia |
52 | Reduced services | Use when therapy is partially provided or dosage/quantity reduced from standard |
53 | Discontinued procedure | Use if medication administration or dispensing was started but subsequently discontinued prior to completion |
54 | Surgical care only | Not typically applicable; retained for reporting continuity when surgery and drug therapy are billed together |
55 | Postoperative management only | Not typically applicable to oral drug; used when post-op care is billed separately |
62 | Two surgeons | Uncommon for an oral drug; included only when multiple surgeons bill related services |
78 | Return to operating room for a related procedure during the postoperative period | Not applicable to oral drug itself; may appear in associated surgical episodes |
80 | Assistant surgeon | Not applicable to dispensing an oral medication |
82 | Assistant surgeon (when qualified resident surgeon not available) | Not applicable to oral drug |
AS | Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery | Not applicable to oral drug billing |
QX | CRNA service furnished with qualified anesthetist: CRNA service with medical direction by a physician | Not applicable to oral drug |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RH0000X | Hematology & Oncology | Oncologists prescribe and manage systemic anti-androgen therapy |
2084P0800X | Urology | Urologists manage prostate cancer patients and may prescribe flutamide |
363L00000X | Clinical Pharmacy | Oncology/specialty pharmacists handle dispensing, counseling, and prior authorization |
2080S0002X | Medical Oncology | Subspecialty focused on systemic cancer therapies |
208000000X | Internal Medicine | Hospital-based internists may coordinate medical management and monitoring |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C61 | Malignant neoplasm of prostate | Primary indication for anti-androgen therapy including flutamide |
D09.0 | Carcinoma in situ of prostate | May prompt local therapy decisions; hormonal therapy sometimes used in management plans |
Z79.851 | Long term (current) use of hormonal agents | Relevant to patients on ongoing flutamide therapy |
E78.5 | Hyperlipidemia, unspecified | Common comorbidity to monitor during systemic cancer therapy |
K71.6 | Toxic liver disease with chronic persistent hepatitis | Important for differential and monitoring because flutamide can cause hepatotoxicity |
R74.0 | Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH] | May be used when monitoring detects abnormal LFTs during therapy |
N18.9 | Chronic kidney disease, unspecified | Comorbidity relevant to medication selection and dosing considerations |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99214 | Office or other outpatient visit, established patient, moderate complexity | Common outpatient visit code used by oncologist or urologist for medication management and monitoring of S0175 |
80076 | Hepatic function panel | Baseline and periodic liver function testing required due to flutamide hepatotoxicity risk |
84153 | Prostate specific antigen (PSA) | Laboratory monitoring of disease response during anti-androgen therapy |
36415 | Collection of venous blood by venipuncture | Specimen collection for LFTs and PSA associated with therapy monitoring |
96372 | Therapeutic, prophylactic, or diagnostic injection (single) | Not used for oral medication but listed when patients receive concurrent injectable supportive therapies |