CMS releases HCPCS codes for new COVID-19 antibody drug

CMS recently announced coding and payment information for the administration of the COVID-19 monoclonal antibody product, bamlanivimab.

The antibody drug received emergency use authorization from the Food and Drug Administration on November 10 for the treatment of mild-to-moderate COVID-19 in certain adult and pediatric patients.

CMS anticipates that bamlanivimab and other, similar therapies will initially be given by drug makers to healthcare providers at no charge. Medicare will not pay for the monoclonal antibody products that providers receive for free but will reimburse providers for the infusion costs.

CMS will pay most providers $309.60 for a one-hour infusion of bamlanivimab and post-administration monitoring in the hospital outpatient setting. The amount will be adjusted according to geographic region, the agency stated.

Healthcare providers can bill for the administration of the monoclonal antibody infusion on a single claim for COVID-19 antibody administration or submit claims on a roster bill. Effective November 9, providers can use the following HCPCS Level II codes to bill for the COVID-19 antibody drug and its administration:

• Q0239, injection, bamlanivimab-xxxx, 700 mg
• M0239, intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring

Healthcare providers should not include the monoclonal antibody code on the claim when the product is provided for free, said CMS.

Additional information on Medicare coding, payment, and billing for monoclonal COVID-19 products and their administration are described in CMS’ Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction.