icd 10 code for monoclonal antibody infusion

How to code monoclonal antibody?

Jan 13, 2022 · In addition to the seven new 2022 ICD-10 procedure codes announced in November, the Centers for Medicare & Medicaid Services on April 1 will implement two new ICD-10 procedure codes for reporting COVID-19 therapeutics. The new codes are for describing the infusion of tixagevimab and cilgavimab monoclonal antibody (code XW023X7), and the …

Which monoclonal antibody is best?

Mar 03, 2022 · What ICD-10 diagnosis code should be billed for the COVID-19 vaccine or mAb infusion? Diagnosis code Z23 is the primary diagnosis required for the COVID-19 vaccine. The mAb infusion billing enter the appropriate diagnosis coded to highest level of specificity (U071 - use as appropriate).

When to administer monoclonal antibodies?

Feb 04, 2022 · For administration of the subsequent doses, use M0240 or M0241. For the initial dose, use M0243 or M0244. M0240 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses. Payment rate: $450.

How do you administer monoclonal antibodies?

If you administer COVID-19 monoclonal antibodies to Medicare patients in traditional health care locations (for example, a hospital outpatient infusion clinic or freestanding infusion clinic), continue to bill HCPCS codes M0240, M0243, M0245, M0247, or M0222, as applicable.

Coding and billing

1. How do I bill for the drug cost for the vaccine and/or the mAb infusion?

Entitlement and eligibility

1. Does the Medicare beneficiary have to have Part B for the COVID-19 vaccine to be covered and paid? And it they do not have Part B what recourse does the provider have?

Federal qualified health centers (FQHC) and rural health clinics (RHC)

1. If I am an FQHC how do I bill for the administration of the COVID-19 vaccine and/or the mAb infusion?

Indian Health Services (IHS)

1. I am an IHS facility billing on the Part A UB-04, can I bill for the all-inclusive rate (AIR) for providing only the administration of the vaccine or mAb infusion?

Questions

Questions regarding topics not currently defined in CMS or Novitas published resources related to COVID-19 services can be sent to COVID-19@CMS.HHS.gov.

When is bamlanivimab approved for use?

On November 9, 2020 , the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the investigational monoclonal antibody therapy, bamlanivimab, for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. Bamlanivimab may only be administered in settings in which health care providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary. Review the Fact Sheet for Health Care Providers EUA of Bamlanivimab regarding the limitations of authorized use.

Can you use bamlanivimab in emergency settings?

Bamlanivimab may only be administered in settings in which health care providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary.

Indian Health Services (IHS), Tribal and Urban Indians

For billing guidance for Indian Health Services, Tribal and Urban Indians please refer to the Indian Health Services COVID-19 vaccine and monoclonal antibody (mAb) infusion administration article.

Federally qualified health centers (FQHCs)

COVID-19 vaccines and their administration will be paid the same way influenza and pneumococcal vaccines and their administration are paid in FQHCs. Influenza and pneumococcal vaccines and their administration are paid at 100 percent of reasonable cost through the cost report.

Rural health clinics (RHCs)

Independent and provider-based RHCs do not include charges for vaccine or administration for COVID-19 or mAb on a claim, reimbursement is made at the time of cost settlement. Claims will process with $0 payment when submitted with only the vaccine and/or administration.

Medicare Advantage beneficiaries to traditional Medicare

CMS provided special guidance for Medicare Advantage plan patients. Submit the vaccine or infusion administration claims for Medicare Advantage plan enrollees to traditional Medicare using the Medicare Beneficiary Identifier (MBI) for processing and payment.

SNFs - enforcement discretion to certain pharmacy billing

In order to facilitate the efficient administration of COVID-19 vaccines and monoclonal antibody treatments to SNF residents, CMS will exercise enforcement discretion with respect to these statutory provisions as well as any associated statutory references and implementing regulations, including as interpreted in pertinent guidance, SNF CB provisions.