Q0220 Note: This product isn’t currently authorized[12] | 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 Note: This product isn’t currently authorized[12] | 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 Note: This product isn’t currently authorized[12] | Tixagev and cilgav inj | AstraZeneca | Injection, tixagevimab and cilgavimab … includes injection and post administration monitoring | $150.50[3] | Code not active during this time period | 12/08/2021 - TBD |
M0221 Note: This product isn’t currently authorized[12] | Tixagev and cilgav inj hm | AstraZeneca | Injection, tixagevimab and cilgavimab … includes injection and post administration monitoring in the home or residence | $250.50[3] | Code not active during this time period | 12/08/2021 - TBD |
Q0222 Note: This product isn’t currently authorized[11] | 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 Note: This product isn’t currently authorized[11] | 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 Note: This product isn’t currently authorized[11] | 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 | 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 | 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 | 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 | $7.569 | 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 |
| Q0224 | Inj, pemivibart, 4500 mg | Invivyd | Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to COVID-19 vaccination, 4500 mg | $7,239.00 | Code not active during this time period | 07/01/2025 - TBD |
| M0224 | Pemivibart infusion | Invivyd | Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known SARS-CoV-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring | $450.00[3] | Code not active during this time period | 03/22/2024 - TBD |
