A version of this article was first published December 14, 2020, by HCPro’s Revenue Cycle Advisor, a sibling publication to HealthLeaders.
CMS recently released two new HCPCS Level II codes for Regeneron’s antibody drugs casirivimab and imdevimab, effective for dates of service on or after November 21. The creation of the new codes comes in response to the Food and Drug Administration issuance of an emergency use authorization for the drug therapies on November 9.
Regeneron’s monoclonal antibody therapies may be used to treat mild to moderate COVID-19 in high-risk patients. The criteria for “high-risk” patients are described in Regeneron’s fact sheet for healthcare providers. The drugs are not authorized for use in patients who are hospitalized or require oxygen therapy due to COVID-19, or for people currently using chronic oxygen therapy because of an underlying comorbidity.
The two drugs are administered together and reported using the following new HCPCS codes:
- Q0243, injection, casirivimab and imdevimab, 2400 mg
- M0243, intravenous infusion, casirivimab and imdevimab includes infusion and post-administration monitoring
CMS set the national average payment rate at approximately $310 for the monoclonal antibody administration. This amount is based on one hour of infusion and post-administration monitoring in the hospital outpatient setting. The agency will adjust the payment allowance for code M0243 based on geographic location.
The payment allowance for the drug injections is currently 1 cent because providers will get initial doses of the COVID-19 antibody therapy for free. Providers should not bill Q0243 if they received the product for free, according to CMS. The agency plans to adjust the payment allowance if there is a need for providers to purchase these products.