Q&A: Revenue code assignment for COVID-19 monoclonal antibodies

Q: What revenue codes are used to prevent triggering a copay or deductible when billing Medicare for COVID-19 monoclonal antibodies?

A: In the COVID-19 FAQs, Section BB, FAQ23, CMS added information on billing monoclonal antibody treatments. To prevent triggering a copay or deductible, CMS instructs institutional providers to bill monoclonal antibodies similar to vaccines as follows:

• Drugs are billed under revenue code 0636, the standard revenue code used for billing drugs with a HCPCS code assigned. Similar to vaccines, drugs received for free should either not be reported or be reported as non-covered with a token charge.
• Administration is billed under revenue code 0771, which is for Vaccine Administration under the Preventative Care Services category, even though this drug or combination of drugs is not technically a vaccine. Payment is set at $310.75, subject to wage adjustment.
• Condition code A6 (Vaccines/100% Medicare Payment).
• Diagnosis code Z23 (Encounter for Immunization).

Additionally, information on all the Medicare Administrative Contractor (MAC) websites instructs providers to reported U07.1 (COVID-19) as a secondary diagnosis code. Presumably, this demonstrates that the patient meets the requirements under the EUAs that the patient has been diagnosed with mild to moderate COVID-19.

For more information, see "Note from the instructor: CMS provides additional information on billing and coding for COVID-19 vaccines and monoclonal antibodies" by Kimberly Hoy, JD, CPC.