COVID-19 Vaccines and Monoclonal Antibodies

Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency

CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once they become available. These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries. This webpage provides the payment allowances and other related information for these products. For more information, review the COVID-19 provider toolkit.

Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration During the Public Health Emergency: (DOS = Date of Service, TBD = To Be Determined)

CPT Code or HCPCS Code	CPT or HCPCS Short Descriptor	Labeler Name	Vaccine/Procedure Name	National Payment Allowance Effective for Claims with DOS on or after 03/15/2021	National Payment Allowance Effective for Claims with DOS through 03/14/2021	Effective Dates
91300	SARSCOV2 VAC 30MCG/0.3ML IM	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Aged 12 years and older) (Purple Cap)	$0.010^[1]	$0.010^[1]	12/11/2020 – TBD
0001A	ADM SARSCOV2 30MCG/0.3ML 1ST	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – First Dose	$40.000^[2]	$16.940^[2]	12/11/2020 – TBD
0002A	ADM SARSCOV2 30MCG/0.3ML 2ND	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Second Dose	$40.000^[2]	$28.390^[2]	12/11/2020 – TBD
0003A	ADM SARSCOV2 30MCG/0.3ML 3RD	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Third Dose	$40.000^[2]	Code not active during this time	08/12/2021 – TBD
0004A^[4]	ADM SARSCOV2 30MCG/0.3ML BST	Pfizer	Pfizer-BioNTech Covid-19 Vaccine (Purple Cap) Administration – Booster	$40.000^[2]	Code not active during this time	09/22/2021 – TBD
91301	SARSCOV2 VAC 100MCG/0.5ML IM	Moderna	Moderna Covid-19 Vaccine (Aged 12 years and older) (Red Cap)	$0.010^[1]	$0.010^[1]	12/18/2020 – TBD
0011A	ADM SARSCOV2 100MCG/0.5ML1ST	Moderna	Moderna Covid-19 Vaccine (Red Cap) Administration – First Dose	$40.000^[2]	$16.940^[2]	12/18/2020 – TBD
0012A	ADM SARSCOV2 100MCG/0.5ML2ND	Moderna	Moderna Covid-19 Vaccine (Red Cap) Administration – Second Dose	$40.000^[2]	$28.390^[2]	12/18/2020 – TBD
0013A	ADM SARSCOV2 100MCG/0.5ML3RD	Moderna	Moderna Covid-19 Vaccine (Red Cap) Administration – Third Dose	$40.000^[2]	Code not active during this time	08/12/2021 – TBD
91302	SARSCOV2 VAC 5X10^{^}10VP/.5MLIM	AstraZeneca	AstraZeneca Covid-19 Vaccine	$0.010^[1]	Code not active during this time	xx/xx/xxxx – TBD
0021A	ADM SARSCOV2 5X10^{^}10VP/.5ML 1	AstraZeneca	AstraZeneca Covid-19 Vaccine Administration – First Dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
0022A	ADM SARSCOV2 5X10^{^}10VP/.5ML 2	AstraZeneca	AstraZeneca Covid-19 Vaccine Administration – Second Dose	$40.000^[2]	Code not active during this time	xx/xx/xxxx – TBD
91303	SARSCOV2 VAC AD26 .5ML IM	Janssen	Janssen Covid-19 Vaccine (Aged 18 years and older)^[3]	$0.010^[1]	$0.010^[1]	02/27/2021 – TBD
0031A	ADM SARSCOV2 VAC AD26 .5ML	Janssen	Janssen Covid-19 Vaccine Administration - First Dose^[3]	$40.000^[2]	$28.390^[2]	02/27/2021 – TBD
0034A	ADM SARSCOV2 VAC AD26 .5ML B	Janssen	Janssen Covid-19 Vaccine Administration - Booster^[3]	$40.000^[2]	Code not active during this time	10/20/2021 – TBD
91304	SARSCOV2 VAC 5MCG/0.5ML IM	Novavax	Novavax Covid-19 Vaccine, Adjuvanted (Aged 12 years and older)	$0.010^[1]	Code not active during this time	07/13/2022 – TBD
0041A	ADM SARSCOV2 5MCG/0.5ML 1ST	Novavax	Novavax Covid-19 Vaccine, Adjuvanted Administration – First Dose	$40.000^[2]	Code not active during this time	07/13/2022 – TBD
0042A	ADM SARSCOV2 5MCG/0.5ML 2ND	Novavax	Novavax Covid-19 Vaccine, Adjuvanted Administration – Second Dose	$40.000^[2]	Code not active during this time	07/13/2022 – TBD
0044A	ADM SARSCOV2 5MCG/0.5ML BST	Novavax	Novavax Covid-19 Vaccine, Adjuvanted Administration - Booster	$40.000^[2]	Code not active during this time	10/19/2022 – TBD
91305	SARSCOV2 VAC 30 MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Aged 12 years and older) (Gray Cap)	$0.010^[1]	Code not active during this time	01/03/2022 – TBD
0051A	ADM SARSCV2 30MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - First dose	$40.000^[2]	Code not active during this time	01/03/2022 – TBD
0052A	ADM SARSCV2 30MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Second dose	$40.000^[2]	Code not active during this time	01/03/2022 – TBD
0053A	ADM SARSCV2 30MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Third dose	$40.000^[2]	Code not active during this time	01/03/2022 – TBD
0054A^[4]	ADM SARSCV2 30MCG TRS-SUCR B	Pfizer	Pfizer-BioNTech Covid-19 Vaccine Pre-Diluted (Gray Cap) Administration - Booster	$40.000^[2]	Code not active during this time	01/03/2022 – TBD
91306	SARSCOV2 VAC 50MCG/0.25ML IM	Moderna	Moderna Covid-19 Vaccine (Aged 18 years and older) (Red Cap) (Low Dose)	$0.010^[1]	Code not active during this time	10/20/2021 – TBD
0064A^[4]	ADM SARSCOV2 50MCG/0.25MLBST	Moderna	Moderna Covid-19 Vaccine (Red Cap) (Low Dose) Administration - Booster	$40.000^[2]	Code not active during this time	10/20/2021 – TBD
91307	SARSCOV2 VAC 10 MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 5 years through 11 years) (Orange Cap)	$0.010^[1]	Code not active during this time	10/29/2021 - TBD
0071A	ADM SARSCV2 10MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - First dose	$40.000^[2]	Code not active during this time	10/29/2021 - TBD
0072A	ADM SARSCV2 10MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Second dose	$40.000^[2]	Code not active during this time	10/29/2021 - TBD
0073A	ADM SARSCV2 10MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Third dose	$40.000^[2]	Code not active during this time	01/03/2022 - TBD
0074A^[4]	ADM SARSCV2 10MCG TRS-SUCR B	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) Administration - Booster	$40.000^[2]	Code not active during this time	05/17/2022 - TBD
91308	SARSCOV2 VAC 3MCG TRS-SUCR	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap)	$0.010^[1]	Code not active during this time	06/17/2022 - TBD
0081A	ADM SARSCOV2 3MCG TRS-SUCR 1	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - First dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
0082A	ADM SARSCOV2 3MCG TRS-SUCR 2	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Second dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
0083A	ADM SARSCOV2 3MCG TRS-SUCR 3	Pfizer	Pfizer-BioNTech Covid-19 Pediatric Vaccine (Aged 6 months through 4 years) (Maroon Cap) Administration - Third dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
91309	SARSCOV2 VAC 50MCG/0.5ML IM	Moderna	Moderna Covid-19 Vaccine (Aged 6 years through 11 years or aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML^[5]	$0.010^[1]	Code not active during this time	03/29/2022 - TBD
0091A	ADM SARSCOV2 50 MCG/.5 ML1ST	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - First dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
0092A	ADM SARSCOV2 50 MCG/.5 ML2ND	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Second dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
0093A	ADM SARSCOV2 50 MCG/.5 ML3RD	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 years through 11 years) (Blue Cap with purple border) Administration - Third dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
0094A^[4]	ADM SARSCOV2 50MCG/0.5 MLBST	Moderna	Moderna Covid-19 Vaccine (Aged 18 years and older) (Blue Cap with purple border) 50MCG/0.5ML Administration - Booster	$40.000^[2]	Code not active during this time	03/29/2022 - TBD
91311	SARSCOV2 VAC 25MCG/0.25ML IM	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) 250MCG/0.25ML	$0.010^[1]	Code not active during this time	06/17/2022 - TBD
0111A	ADM SARSCOV2 25MCG/0.25ML1ST	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - First dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
0112A	ADM SARSCOV2 25MCG/0.25ML2ND	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Second dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
0113A	ADM SARSCOV2 25MCG/0.25ML3RD	Moderna	Moderna Covid-19 Pediatric Vaccine (Aged 6 months through 5 years) (Blue Cap with magenta border) Administration - Third dose	$40.000^[2]	Code not active during this time	06/17/2022 - TBD
91312	SARSCOV2 VAC BVL 30MCG/0.3M	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Gray Cap)	$0.010^[1]	Code not active during this time	08/31/2022 – TBD
0124A	ADM SARSCV2 BVL 30MCG/.3ML B	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent (Gray Cap) Administration – Booster Dose	$40.000^[2]	Code not active during this time	08/31/2022 – TBD
91313	SARSCOV2 VAC BVL 50MCG/0.5ML	Moderna	Moderna COVID-19 Vaccine, Bivalent Product (Aged 12 years and older) (Dark Blue Cap with gray border)^[6]	$0.010^[1]	Code not active during this time	08/31/2022 – TBD^[6]
0134A	ADM SARSCV2 BVL 50MCG/.5ML B	Moderna	Moderna COVID-19 Vaccine, Bivalent (Aged 12 years and older) (Dark Blue Cap with gray border) Administration – Booster Dose^[6]	$40.000^[2]	Code not active during this time	08/31/2022 – TBD^[6]
91314	SARSCOV2 VAC BVL 25MCG/0.25ML	Moderna	Moderna COVID-19 Vaccine, Bivalent Product (Aged 6 years through 11 years) (Dark Blue Cap with gray border)	$0.010^[1]	Code not active during this time	10/12/2022 – TBD
0144A	ADM SARSCV2 BVL 25MCG/.25ML B	Moderna	Moderna COVID-19 Vaccine, Bivalent (Aged 6 years through 11 years) (Dark Blue Cap with gray border) Administration – Booster Dose	$40.000^[2]	Code not active during this time	10/12/2022 – TBD
91315	SARSCOV2 VAC BVL 10MCG/0.2ML	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap)	$0.010^[1]	Code not active during this time	10/12/2022 – TBD
0154A	ADM SARSCV2 BVL 10MCG/.2ML B	Pfizer	Pfizer-BioNTech COVID-19 Vaccine, Bivalent Product (Aged 5 years through 11 years) (Orange Cap) Administration – Booster Dose	$40.000^[2]	Code not active during this time	10/12/2022 – TBD
M0201	Covid-19 vaccine home admin	Home vaccine admin	Covid-19 vaccine administration inside a patient's home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient's home	$35.50^[2]	Code not active during this time	06/08/2021 - TBD

^[1] Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date. Providers should not bill for the product if they received it for free.

^[2] These rates will also be geographically adjusted for many providers. For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), files with the geographically adjusted payment rates for COVID-19 vaccine administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

^[3] Johnson & Johnson COVID-19 vaccine. On May 5, 2022, the FDA limited the authorized use of the Janssen COVID-19 vaccine.

^[4] Administration booster codes should be billed for all applicable booster doses as approved and/or authorized by the FDA.

^[5] On June 17, 2022, FDA authorized the 50MCG/0.5ML presentation of the Moderna COVID-19 Vaccine to provide primary series doses in individuals 6 years through 11 years of age in addition to the 3/29/2022 FDA authorization to provide booster vaccination doses in individuals 18 years and older.

^[6] On October 12, 2022, the FDA authorized the Moderna bivalent product (dark blue cap with gray border) and its administration for use as a single booster dose in individuals 12 years through 17 years of age in addition to the 8/31/2022 FDA authorization as a single booster dose in individuals 18 years and older.

Payment Allowances and Effective Dates for COVID-19 Monoclonal Antibodies and their Administration During the Public Health Emergency:

HCPCS Code	HCPCS Short Descriptor	Labeler Name	Vaccine/Procedure Name	National Payment Allowance Effective for Claims with DOS on or after 05/6/2021	National Payment Allowance Effective for Claims with DOS through 05/5/2021	Effective Dates
Q0220	Tixagev and cilgav, 300mg	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg	$0.010^[1]	Code not active during this time period	12/08/2021 - TBD
Q0221	Tixagev and cilgav, 600mg	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg	$0.010^[1]	Code not active during this time period	02/24/2022 - TBD
M0220	Tixagev and cilgav inj	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring	$150.50^[3]	Code not active during this time period	12/08/2021 - TBD
M0221	Tixagev and cilgav inj hm	AstraZeneca	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes 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	$250.50^[3]	Code not active during this time period	12/08/2021 - TBD
Q0222	Bebtelovimab 175 mg	Eli Lilly	Injection, bebtelovimab, 175 mg	$2394.00^{[1] [1a]}	Code not active during this time period	02/11/2022 - TBD
M0222	Bebtelovimab injection	Eli Lilly	Intravenous injection, bebtelovimab, includes injection and post administration monitoring	$350.50^[3]	Code not active during this time period	02/11/2022 - TBD
M0223	Bebtelovimab injection home	Eli Lilly	Intravenous injection, bebtelovimab, includes 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	$550.50^[3]	Code not active during this time period	02/11/2022 - TBD
Q0239	Bamlanivimab-xxxx	Eli Lilly	Injection, bamlanivimab, 700 mg	Code not active during this time period	$0.010^[1]	11/10/2020 – 04/16/2021^[4]
M0239	Bamlanivimab-xxxx infusion	Eli Lilly	Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring	Code not active during this time period	$309.600^[3]	11/10/2020 – 04/16/2021^[4]
Q0240^[6] Note: This product isn’t currently authorized^[9]	Casirivi and imdevi 600mg	Regeneron	Injection, casirivimab and imdevimab, 600 mg	$0.010^[1]	Code not active during this time period	07/30/2021 – TBD
M0240^[6] Note: This product isn’t currently authorized^[9]	Casiri and imdev repeat	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses	$450.00^[3]	Code not active during this time period	07/30/2021 – TBD
M0241^[6] Note: This product isn’t currently authorized^[9]	Casiri and imdev repeat hm	Regeneron	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	$750.00^[3]	Code not active during this time period	07/30/2021 – TBD
Q0243 Note: This product isn’t currently authorized^[9]	Casirivimab and imdevimab	Regeneron	Injection, casirivimab and imdevimab, 2400 mg	$0.010^[1]	$0.010^[1]	11/21/2020 – TBD
M0243 Note: This product isn’t currently authorized^[9]	Casirivi and imdevi inj	Regeneron	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring	$450.00^[3]	$309.600^[3]	11/21/2020 – TBD
Q0244^[5] Note: This product isn’t currently authorized^[9]	Casirivi and imdevi 1200 mg	Regeneron	Injection, casirivimab and imdevimab, 1200 mg	$0.010^[1]	$0.010^[1]	06/03/2021 – TBD
M0244 Note: This product isn’t currently authorized^[9]	Casirivi and imdevi inj hm	Regeneron	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	$750.00^[3]	Code not active during this time period	05/06/2021 – TBD
Q0245^[8] Note: This product isn’t currently authorized^[9]	Bamlanivimab and etesevima	Eli Lilly	Injection, bamlanivimab and etesevimab, 2100 mg	$0.010^[1]	$0.010^[1]	02/09/2021 – TBD
M0245^[8] Note: This product isn’t currently authorized^[9]	Bamlan and etesev infusion	Eli Lilly	intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring	$450.00^[3]	$309.600^[3]	02/09/2021 – TBD
M0246^[8] Note: This product isn’t currently authorized^[9]	Bamlan and etesev infus home	Eli Lilly	Intravenous infusion, bamlanivimab 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	$750.00^[3]	Code not active during this time period	05/06/2021 – TBD
Q0247^[7] Note: This product isn’t currently authorized^[10]	Sotrovimab	GSK	Injection, sotrovimab, 500 mg	$2394.00	Code not active during this time period	05/26/2021 – TBD
M0247 Note: This product isn’t currently authorized^[10]	Sotrovimab infusion	GSK	Intravenous infusion, sotrovimab, includes infusion and post administration monitoring	$450.00^[3]	Code not active during this time period	05/26/2021 – TBD
M0248 Note: This product isn’t currently authorized^[10]	Sotrovimab inf, home admin	GSK	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	$750.00^[3]	Code not active during this time period	05/26/2021 – TBD
Q0249^[2]	Tocilizumab for COVID-19	Genentech	Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg	$6.572	Code not active during this time period	06/24/2021 - TBA
M0249	Adm Tocilizu COVID-19 1st	Genentech	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose	$450.00^[3]	Code not active during this time period	06/24/2021 - TBA
M0250	Adm Tocilizu COVID-19 2nd	Genentech	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose	$450.00^[3]	Code not active during this time period	06/24/2021 - TBA

^[1] Providers shouldn't bill for the product if they received it for free through the USG-purchased inventory.

^[1a] Payment rate effective for dates of service on or after August 15, 2022. Providers should only bill Medicare for commercially-purchased products.

^[2] Given the limited clinical situations allowed under the EUA, providers should only bill for tocilizumab on a 12x type of bill (TOB).

^[3] These rates will be geographically adjusted for many providers. For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), files with the geographically adjusted payment rates for monoclonal antibody administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

^[4]On April 16, 2021, the FDA revoked the EUA that allowed for the investigational monoclonal antibody therapy bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients. As a result, Medicare won't pay for claims with HCPCS codes M0239 or Q0239 with dates of service after April 16, 2021.

^[5]On June 3, 2021, the FDA revised the EUA for casirivimab and imdevimab to change the allowed dosing regimen from 2400 mg to 1200 mg, and allow providers to administer the combination product by subcutaneous injection in limited circumstances. As a result, CMS issued a new product code for casirivimab and imdevimab (Q0244) and updated the descriptors for the existing administration codes (M0243/M0244).

^[6]On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. As a result, CMS issued a new product code for casirivimab and imdevimab of 600 mg (Q0240), and 2 new codes for the administration of repeat doses of casirivimab and imdevimab (M0240/M0241). Providers and suppliers who administer casirivimab and imdevimab for PEP should use M0243 or M0244 for administering the first dose and M0240 or M0241 for administering subsequent repeat doses.

^[7] When the government provides monoclonal antibody products to treat COVID-19 for free, providers should only bill for the administration; don’t include the monoclonal antibody product codes on these claims. If you got the product for free, and your systems require a product code to bill for the administration, enter $0.01 for the billed amount.

^[8] On September 16, 2021, the FDA revised the EUA for bamlanivimab and etesevimab, administered together, to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. Providers and suppliers should use Q0245 and M0245 or M0246 to bill for administering bamlanivimab and etesevimab for PEP.

^[9] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, this product isn’t currently authorized in any U.S region and may not be administered for treatment or post-exposure prevention of COVID-19 under the EUA until further notice by the FDA.

^[10] On April 5, 2022, the FDA announced that, due to the high frequency of the Omicron BA.2 sub-variant, this product isn’t currently authorized in any U.S. region and may not be administered to treat COVID-19 until further notice by the FDA.

Additional Resources:

Following links contain helpful information for providers. Product NDCs can be found in the EUA Fact Sheet for Healthcare Providers and can be used to identify the appropriate HCPCS codes for each product and its administration. NDC - HCPCS crosswalk is available in CMS ASP crosswalk zip folder. Long, medium, and short descriptors of COVID-19 CPT codes are available from AMA website.

Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction

COVID-19 NDC-HCPCS crosswalk

COVID-19 Vaccination Resources at CDC

COVID-19 CPT vaccine and immunization codes - AMA

Quick reference guide to the coding structure for COVID-19 vaccine CPT reporting

Bamlanivimab Emergency Use Authorization

Casirivimab and imdevimab Emergency Use Authorization) (ZIP)

Bamlanivimab and etesevimab Emergency Use Authorization

Sotrovimab Emergency Use Authorization

Tocilizumab Emergency Use Authorization

Evusheld® (tixagevimab co-packaged with cilgavimab) Emergency Use Authorization

Bebtelovimab Emergency Use Authorization (PDF)