Alerts

COVID-19 Monoclonal Antibody Infusion

11/21/2021


TO: Outpatient Service Providers, Physicians, Nurse Practitioners, Physician Assistants, Federally Qualified Health Centers and Rural Health Clinics

RE:  COVID-19 Monoclonal Antibody Infusion

As Alabama Medicaid continues to monitor the COVID-19 national emergency in Alabama, Medicaid is adding the following procedure codes for coverage:

CPT  CODE

SUMMARY

Effective date

Q0240

Injection, casirivimab and imdevimab, 600 mg.

7/30/2021

M0240

Intravenous infusion, or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses.

7/30/2021

M0241

Intravenous infusion, or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, 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 emergency, subsequent repeat doses.

7/30/2021

Q0243

Injection, casirivimab and imdevimab, 2400 mg.

11/21/2020

Q0244

Injection, casirivimab.

6/3/2021

M0243

Intravenous infusion, or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring.

11/21/2020

M0244

Intravenous infusion, or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, 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 emergency.

5/6/2021

Q0245

Injection, bamianivimab and etesevimab, 2100 mb.

2/9/2021

M0245

Intravenous infusion, bamianivimab and etesevimab, includes infusion and post administration monitoring.

2/9/2021

M0246

Intravenous infusion, bamianivimab 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 emergency.

5/6/2021

Q0247

Injection, sotrovimab, 500 mg.

5/26/2021

M0247

Intravenous infusion, sotrovimab, includes infusion and post administration monitoring.

5/26/2021

M0248

Intravenous infusion, sotrovimab, 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 emergency.

5/26/2021


Providers may submit claims for dates of service on or after the effective dates for each procedure code as listed above.

FQHCs/RHCs should submit claims for the above procedure codes outside of the encounter rate.

Providers may find the reimbursement rates for the COVID-19 testing procedure codes on Medicaid’s website at www.Medicaid.Alabama.gov by selecting Fee Schedules under the Providers tab.
 
As a reminder, providers must deliver services within their scope of practice and have the proper certification and licensure to perform these tests.  

During the COVID-19 emergency, it is important to file claims as quickly as possible to ensure payment from Medicaid to Medicaid providers close to the date of service. The Centers for Medicare and Medicaid Services (CMS) has increased the federal matching percentage for the emergency time frame, but states can only receive the increased match on claims paid during the emergency. Providers should include appropriate COVID-19 diagnosis code(s) on claims submitted to help with tracking of COVID-19.
 
For questions, please visit the Medicaid website at www.Medicaid.Alabama.gov, or call the Medicaid Fiscal Agent at 1-800-688-7989 .

Physicians, Nurse Practitioners, and Physician Assistants can email questions to Jean.Wackerle@medicaid.alabama.gov

Laboratory service providers can email questions to Susan.Watkins@medicaid.alabama.gov.

Outpatient service providers can email questions to
Lynne.Davenport@medicaid.alabama.gov or Callie.Johnson@medicaid.alabama.gov.      


The Current Procedural Terminology (CPT) and Current Dental Terminology (CDT) codes descriptors, and other data are copyright © 2021 American Medical Association and © 2021 American Dental Association (or such other date publication of CPT and CDT). All rights reserved. Applicable FARS/DFARS apply.