Summary & Overview
HCPCS Level II S0183: Prochlorperazine Maleate Oral 5 mg
HCPCS Level II code S0183 denotes prochlorperazine maleate, oral, 5 mg — an oral antiemetic commonly used to manage nausea and vomiting in ambulatory settings. The code identifies a specific drug formulation and strength for billing and claims when medications are provided outside Medicare Part B coverage (the Medicare-specific alternative is Q0164). Nationally, accurate use of this HCPCS Level II code supports consistent reporting of medication dispensing in outpatient pharmacies and ambulatory clinics and aids payers in adjudicating drug benefit claims.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for prochlorperazine oral dosing, common service settings, and guidance on which payers are relevant to coverage discussions. The publication also highlights benchmarking and policy considerations related to billing for oral antiemetic medications, how HCPCS Level II coding interfaces with Medicare billing pathways, and practical notes on claim submission variability across payers.
The piece serves clinicians, billing professionals, and policy analysts who need a national-level reference for correct identification and context of HCPCS Level II code S0183. Data not available in the input.
Billing Code Overview
HCPCS Level II code S0183 describes prochlorperazine maleate, oral, 5 mg, intended for use in outpatient medication dispensing or administration when not covered under Medicare Part B (for circumstances falling under the Medicare statute, use Q0164). The service type is oral antiemetic medication. The typical site of service is outpatient pharmacy or ambulatory clinic where oral medications are dispensed or administered to patients.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult presenting to an outpatient clinic, urgent care, or emergency department with acute nausea and/or vomiting, often associated with conditions such as migraine headache, gastroenteritis, medication-induced nausea (e.g., chemotherapy-related emesis not covered by separate oncology drug billing), or vestibular disorders. The clinician evaluates the patient, documents history, vital signs, and relevant exam findings, and determines an oral antiemetic is appropriate. The clinician orders S0183 — prochlorperazine maleate, oral, 5 mg — for administration and documents the indication, dose, route, and expected therapeutic effect. If the patient cannot tolerate oral intake, an alternative formulation or route is selected. Medication administration is recorded in the medical record and on the claim form with the appropriate diagnosis code(s) for the underlying cause of nausea/vomiting, and any applicable modifier to reflect special circumstances (for example, unusual procedural service or a reduced service). Typical sites of service include outpatient clinic, urgent care, and emergency department. Usual providers ordering/administering this medication include family medicine physicians, emergency medicine physicians, internal medicine physicians, nurse practitioners, and physician assistants.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier required / standard service |