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HCPCS Q0163 · Level II · Q code

Q0163: Diphenhydramine hydrochloride, 50 mg, oral, FDA approved prescription anti-emetic, HCPCS Level II Q code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026); Medicare Coverage Database LCD export: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file; weekly, every Thursday for the Medicare Coverage Database LCD export.

Key facts for Q0163

Medicare payment
no PFS amount
PFS status X
Coverage code
D
special coverage instructions apply
Practitioner MUE
0
MAI 3
OPPS status
SI N
Items and Services packaged into APC rates
NCCI PTP pairs
0
practitioner file
LCDs and articles
1 / 0

TL;DR

HCPCS Level II Q0163 reads "Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen" in the October 2026 file; it dates from 1998. The physician fee schedule lists Q0163 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. MUE limits for Q0163: practitioner 0 (MAI 3, Oral Medication; Not Payable); hospital outpatient 6 (MAI 3, Prescribing Information); DME supplier 13 (MAI 3, CMS Policy). 1 active LCD lists Q0163: L33827 (Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)). OPPS status indicator N: Items and Services packaged into APC rates. HCPCS record: BETOS O1D (chemotherapy); pricing indicator 51; type of service 1 (medical care). Nearby codes: Q0112, Q0111, Q0092, Q0091.

Q0163 descriptor and code status

The October 2026 HCPCS Level II file describes Q0163 as “Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen”. It sits in the Q section (temporary codes), listed with the other Q codes for services and supplies (non-drug). Although searches often call it the "Q0163 CPT code", Q0163 is a HCPCS Level II code maintained by CMS, not an AMA CPT code; both go in the same procedure-code field on the claim.

HCPCS file attributes of Q0163
FieldValue
Short descriptorDiphenhydramine hcl 50mg
Added to HCPCS1998-04-01
Last actionN (no maintenance), effective 1998-04-01
Coverage codeD: special coverage instructions apply
Pricing indicator51: drugs
BETOS categoryO1D: chemotherapy
Type of service1: medical care
Statute4557

Medicare payment for Q0163

The physician fee schedule lists Q0163 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it. The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator N (Items and Services packaged into APC rates), with no separate OPPS payment rate.

Ambulatory surgical center (Addendum BB)

Payment indicator N1 (Packaged service/item; no separate payment made).

Medically Unlikely Edits for Q0163

MUE limits for Q0163: practitioner 0 (MAI 3, Oral Medication; Not Payable); hospital outpatient 6 (MAI 3, Prescribing Information); DME supplier 13 (MAI 3, CMS Policy). The practitioner MUE is a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation.

MUE values for Q0163 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services03 Date of Service Edit: ClinicalOral Medication; Not Payable
Facility outpatient hospital63 Date of Service Edit: ClinicalPrescribing Information
DME supplier133 Date of Service Edit: ClinicalCMS Policy

The MUE lookup for Q0163 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists Q0163 in v323r0.

Q0163 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check Q0163 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for Q0163

1 active Local Coverage Determination and 0 billing and coding articles list Q0163. Each applies only in its contractor's jurisdiction, and the article carries the diagnosis codes that support the item or service.

Denials to expect on Q0163

CARC 50 · N115

the diagnosis or documentation does not meet the LCD or billing article that lists Q0163

CARC 151 · N362

units of Q0163 exceed the practitioner MUE of 0 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for Q0163 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for Q0163 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS Q0163

What does HCPCS code Q0163 describe?

"Diphenhydramine hydrochloride, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at time of chemotherapy treatment not to exceed a 48 hour dosage regimen" (short descriptor "Diphenhydramine hcl 50mg"), in the Q section (temporary codes). Added 1998-04-01.

Is Q0163 a CPT code?

No: CMS maintains Q0163 in HCPCS Level II, while the AMA maintains CPT. People do search "Q0163 CPT code", and it goes in the same procedure-code field.

What does Medicare pay for Q0163?

The physician fee schedule lists Q0163 with status X (statutory exclusion: not a physician service under the fee schedule), so the PFS carries no national amount for it.

How many units of Q0163 can be billed per day?

MUE limits for Q0163: practitioner 0 (MAI 3, Oral Medication; Not Payable); hospital outpatient 6 (MAI 3, Prescribing Information); DME supplier 13 (MAI 3, CMS Policy). For the practitioner MUE (MAI 3), units above 0 deny for the day but can be paid on appeal with documentation; denials arrive as CARC 151.

Does Medicare cover Q0163?

Coverage code D (special coverage instructions apply). 1 active LCD lists Q0163: L33827 (Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.