New Codes, Rates for COVID-19 Therapeutics



Healthcare providers administering monoclonal antibodies to Medicare patients with COVID-19 will soon see an increase in reimbursement, especially if providing this service in an unconventional setting.

For dates of service (DOS) on or after May 6, the national average payment rate for administering monoclonal antibodies is increased from $310 to $450 in most healthcare settings. The Centers for Medicare & Medicaid Services (CMS) is also establishing two new HCPCS Level II codes (M0244 and M0246) for treatment provided in the patient’s home or temporary lodging (e.g., hotel/motel, cruise ship, hostel, or homeless shelter) with a national payment rate of $750.

Latest Codes and Payment Rates

CMS has updated its COVID-19 Vaccines and Monoclonal Antibodies website to reflect the new codes and payment rates, as shown here:

CodeDescriptorLabelerNational Payment Allowance for DOS 5/6/2021 or afterNational Payment Allowance for DOS through 5/5/2021Effective Dates
Q0239Injection, bamlanivimab-xxxx, 700 mgEli LillyN/A$0.01011/10/2020 – 04/16/2021
M0239Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoringEli LillyN/A$309.60011/10/2020 – 04/16/2021
Q0243Injection, casirivimab and imdevimab, 2400 mgRegeneron$0.010$0.01011/21/2020 – TBD
M0243Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoringRegeneron$450.00$309.60011/21/2020 – TBD
M0244Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergencyRegeneron$750.00N/A5/6/2021 – TBD
Q0245Injection, bamlanivimab and etesevimab, 2100 mgEli Lilly$0.010$0.0102/9/2021 – TBD
M0245Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoringEli Lilly$450.00$309.6002/9/2021 – TBD
M0246Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergencyEli Lilly$750.00N/A5/6/2021 – TBD
N/A – not applicable after May 5, 2021

Important Coverage Update

The Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for bamlanivimab on Nov. 9 2020, and for casirivimab and imdevimab, when administered together, on Nov. 21, 2020, for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and requiring hospitalization.

On April 16, however, the FDA revoked the EUA that allowed for bamlanivimab to be used alone for such treatment. Due to this revocation, Medicare will not pay for claims with HCPCS Level II codes M0239 or Q0239 with DOS after April 16.

Monoclonal antibody products are not eligible for the New COVID-19 Treatments Add-on Payment under the Inpatient Prospective Payment System.

code-books-shipping

Latest posts by Renee Dustman (see all)

About Has 730 Posts

Renee Dustman, BS, AAPC MACRA Proficient, is managing editor – content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications – Journalism. Renee has more than 30 years’ experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

Translate »
%d bloggers like this: