CMS announced yesterday that Medicare payment will be available for both the purchase and administration of bamlanivimab, which can be used to treat mild-to-moderate COVID-19 in certain adult and pediatric patients, according to the FDA’s recent emergency use authorization.
However, the drug is expected to be free for healthcare providers at first, according to the announcement.
The Medicare payment rate for the administration of bamlanivimab will be $309.60. The rate will cover one hour of infusion and post-administration monitoring in the hospital outpatient setting and will be adjusted according to geographic region, the agency explained in an instruction guide accompanying the announcement.
Healthcare providers will be able to bill for the administration of the drug’s infusion on a single claim for COVID-19 monoclonal antibody administration or they can submit claims on a roster bill.
The FDA’s emergency use authorization sets specific criteria for who is eligible to receive the COVID-19 antibody drug and providers will need to provide medical documentation that not only supports the medical necessity of the drug’s administration, but also that it meets the terms of the FDA’s authorization.
CMS said healthcare providers should only seek Medicare reimbursement for the administration of the COVID-19 antibody drug if they received the drug for free. In that case, providers should not include the codes for the monoclonal antibody on the claim, the agency stated.
The codes for the COVID-19 antibody drug and its administration are:
Q0239: Long descriptor: Injection, bamlanivimab-xxxx, 700 mg Short descriptor: bamlanivimab-xxxx
M0239: Long Descriptor: intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring Short Descriptor: bamlanivimab-xxxx infusion
References:
https://revcycleintelligence.com/news/cms-details-medicare-payment-for-new-covid-19-antibody-drug