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.