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HCPCS Q0162 · Level II · Part B drug

HCPCS Q0162: Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for Q0162

Billing unit
1 MG
Ondansetron oral
ASP payment limit
$0.016
October 2026; +0.0% vs July 2026
Practitioner MUE
0
MAI 3
OPPS status
SI N
NCCI exposure
0 col-2 pairs
Coverage articles
0
none list this code

TL;DR

HCPCS Q0162 is the Level II code for Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $0.016 per billing unit, up 0.0% from July 2026. The practitioner MUE allows up to 0 units per date of service (MAI 3). Under OPPS it carries status indicator N. Oral drugs under Part B are payable only in the specific statutory categories (for example oral anticancer or antiemetic drugs with a self-administration exception), so the diagnosis and the regimen must match that category. The ASP crosswalk maps 114 NDCs to it, sold as Ondansetron HCl, Ondansetron ODT, Ondansetron by Major Pharmaceuticals, Northstar RxLLC, PD-Rx Pharmaceuticals, Inc.. No current Billing and Coding Article lists Q0162, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for Q0162 at $0.016 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $0.016 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for Q0162
QuarterPayment limitPerCoinsurance
October 2026$0.0161 MG20%
July 2026$0.0161 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 114 NDCs from 13 labelers to Q0162. Report the NDC in the claim's drug segment and bill the number of Q0162 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to Q0162
NDCDrug nameLabelerPackage sizeBilling units / package
00904-6551-61Ondansetron HClMajor Pharmaceuticals100 × 1400
00904-6552-61Ondansetron HClMajor Pharmaceuticals100 × 1800
16714-0159-01Ondansetron HClNorthstar RxLLC30 × 1120
16714-0160-01Ondansetron HClNorthstar RxLLC30 × 1240
16714-0200-30Ondansetron ODTNorthstar RxLLC30 × 1120
16714-0201-10Ondansetron ODTNorthstar RxLLC10 × 180
16714-0201-30Ondansetron ODTNorthstar RxLLC30 × 1240
16714-0671-02OndansetronNorthstar RxLLC50 × 140
43063-0792-06Ondansetron HClPD-Rx Pharmaceuticals, Inc.6 × 148
43063-0857-02Ondansetron ODTPD-Rx Pharmaceuticals, Inc.2 × 18
43063-0857-04Ondansetron ODTPD-Rx Pharmaceuticals, Inc.4 × 116
43063-0857-05Ondansetron ODTPD-Rx Pharmaceuticals, Inc.5 × 120
43063-0857-06Ondansetron ODTPD-Rx Pharmaceuticals, Inc.6 × 124
43063-0857-10Ondansetron ODTPD-Rx Pharmaceuticals, Inc.10 × 140
43063-0857-20Ondansetron ODTPD-Rx Pharmaceuticals, Inc.20 × 180
43063-0870-04Ondansetron ODTPD-Rx Pharmaceuticals, Inc.4 × 132
43063-0870-10Ondansetron ODTPD-Rx Pharmaceuticals, Inc.10 × 180
50090-1128-01Ondansetron ODTA-S Medication Solutions30 × 1240
50090-1200-00Ondansetron ODTA-S Medication Solutions10 × 140
50090-1200-01Ondansetron ODTA-S Medication Solutions20 × 180
50090-1200-02Ondansetron ODTA-S Medication Solutions5 × 120
50090-1200-03Ondansetron ODTA-S Medication Solutions30 × 1120
50090-1201-00Ondansetron ODTA-S Medication Solutions10 × 140
50090-1658-00Ondansetron ODTA-S Medication Solutions10 × 140
50090-1658-01Ondansetron ODTA-S Medication Solutions20 × 180
50090-1658-02Ondansetron ODTA-S Medication Solutions5 × 120
50090-1658-03Ondansetron ODTA-S Medication Solutions30 × 1120
50090-1659-00Ondansetron ODTA-S Medication Solutions10 × 140
50090-1660-00Ondansetron ODTA-S Medication Solutions4 × 132
50090-1660-01Ondansetron ODTA-S Medication Solutions30 × 1240
50090-1660-02Ondansetron ODTA-S Medication Solutions10 × 180
50090-1660-03Ondansetron ODTA-S Medication Solutions20 × 1160
50090-2343-00Ondansetron ODTA-S Medication Solutions10 × 140
50090-2343-01Ondansetron ODTA-S Medication Solutions20 × 180
50090-2343-02Ondansetron ODTA-S Medication Solutions5 × 120
50090-2343-03Ondansetron ODTA-S Medication Solutions30 × 1120
50090-3178-00Ondansetron HClA-S Medication Solutions10 × 140
50090-3178-01Ondansetron HClA-S Medication Solutions6 × 124
50090-3178-02Ondansetron HClA-S Medication Solutions20 × 180
50090-3178-04Ondansetron HClA-S Medication Solutions3 × 112
50090-3178-05Ondansetron HClA-S Medication Solutions12 × 148
50090-3185-00Ondansetron HClA-S Medication Solutions4 × 132
50090-3185-01OndansetronA-S Medication Solutions10 × 180
50090-3185-02OndansetronA-S Medication Solutions3 × 124
50090-3185-03OndansetronA-S Medication Solutions30 × 1240
50090-3185-04OndansetronA-S Medication Solutions6 × 148
50090-3769-00OndansetronA-S Medication Solutions4 × 132
50090-3769-01OndansetronA-S Medication Solutions10 × 180
50090-3769-03OndansetronA-S Medication Solutions30 × 1240
50090-3769-04OndansetronA-S Medication Solutions6 × 148
50090-4632-00Ondansetron ODTA-S Medication Solutions4 × 132
50090-4632-01Ondansetron ODTA-S Medication Solutions30 × 1240
50090-4632-02Ondansetron ODTA-S Medication Solutions10 × 180
50090-4632-03Ondansetron ODTA-S Medication Solutions20 × 1160
50090-4671-00OndansetronA-S Medication Solutions4 × 132
50090-4671-01OndansetronA-S Medication Solutions10 × 180
50090-4671-02OndansetronA-S Medication Solutions3 × 124
50090-4671-03OndansetronA-S Medication Solutions30 × 1240
50090-4671-04OndansetronA-S Medication Solutions6 × 148
50090-5346-01Ondansetron ODTA-S Medication Solutions30 × 1240
Showing 60 of 114 NDCs.

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for Q0162. For practitioners the limit is 0 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for Q0162 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalOral Medication; Not Payable
Facility outpatient hospital243 Date of Service Edit: ClinicalPrescribing Information
DME supplier403 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists Q0162 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

Q0162 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists Q0162 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, Q0162 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for Q0162 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks Q0162 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS Q0162

What does HCPCS code Q0162 describe?

Q0162 is defined by CMS as "Ondansetron 1 mg, oral, fda approved prescription anti-emetic, for use as a". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for Q0162 in October 2026?

The ASP-based payment limit is $0.016 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $0.016.

How many units of Q0162 can be billed per day?

The practitioner Medically Unlikely Edit is 0 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Oral Medication; Not Payable" as the rationale.

Which NDCs map to Q0162?

The October 2026 ASP crosswalk lists 114 NDCs from 13 labelers: Ondansetron HCl (Major Pharmaceuticals); Ondansetron HCl (Northstar RxLLC); Ondansetron ODT (Northstar RxLLC); Ondansetron (Northstar RxLLC). For example NDC 00904-6551-61 is a 100 package equal to 400 billing units. The crosswalk's billing-units-per-package figure converts each package into Q0162 units.

Does Q0162 have NCCI bundling edits?

No active practitioner PTP pairs list Q0162 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.