Does Q0167 require prior authorization?

Yes, Q0167 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for Q0167?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`Q0167`, Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; lack of a completed SWO will result in denial.
For DMEPOS base items requiring WOPD, the supplier must have a signed WOPD prior to delivery; WOPD must list the base item and may list separately billed associated options/accessories/supplies.

Suppliers must contact the beneficiary for DMEPOS refills and document an affirmative response prior to dispensing refills; contact must occur no sooner than 30 calendar days prior to expected end of current supply.

Treating practitioners may bill only if they are enrolled as a DMEPOS supplier with the National Supplier Clearinghouse, are dispensing the drug to the beneficiary, and are authorized by the State to dispense drugs as part of their license.

Key Coverage Criteria

Coverage requires that the item meet Medicare statutory criteria (eligible benefit category and be reasonable and necessary) per Social Security Act §1862(a)(1)(A).
An FDA‑approved oral 3‑drug antiemetic regimen consisting of an oral NK‑1 antagonist plus an oral 5‑HT3 antagonist and dexamethasone (HCPCS J8540) is covered when administered to beneficiaries receiving one or more of the following chemotherapeutic agents: Alemtuzumab, Azacitidine, Bendamustine, Carboplatin, Carmustine, Cisplatin, Clofarabine, Cyclophosphamide, Cytarabine, Dacarbazine, Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Ifosfamide, Irinotecan, Lomustine, Mechlorethamine, Oxalipla [...]

4 Active Policies

BCBSLA-00599-96D7DD2C52, 00599 Syndros (dronabinol)

HEALTHNET_OR-HNOR-DRONABINOL-MARINOL-SYNDROS-CP-PMN-159-2B0B7B3E88, Dronabinol (Marinol, Syndros); CP.PMN.159

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

L33827, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

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Q0167, Dronabinol, 2.5 mg, oral, fda approved prescription anti-emetic, for use as a