2021-06-17-MLNC

Date
2021-06-17
Subject
COVID-19: EUAs for Monoclonal Antibody Products
mln connects logo


Thursday, June 17, 2021
 

News

Compliance

Events

MLN Matters® Articles

Publications

Multimedia

View this edition as PDF (PDF)
 

News

 

COVID-19: EUA for Sotrovimab Monoclonal Antibody Product

On May 26, the FDA released an Emergency Use Authorization (EUA) for sotrovimab, a COVID-19 monoclonal antibody product. CMS created new HCPCS codes, effective May 26, for sotrovimab and to administer sotrovimab in health care settings and the home:

Q0247:

  • Long descriptor: Injection, sotrovimab, 500 mg
  • Short descriptor: Sotrovimab
  • Price: The government won’t provide this drug for free; visit the COVID-19 Vaccines and Monoclonal Antibodies webpage for pricing information (available soon)

M0247: 

  • Long Descriptor: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring
  • Short Descriptor: Sotrovimab infusion
  • Price: $450.00 per infusion

M0248:

  • Long Descriptor: 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
  • Short Descriptor: Sotrovimab inf, home admin
  • Price: $750.00 per infusion

More Information:

 

COVID-19: EUA for Regeneron Monoclonal Antibody Product Casirivimab & Imdevimab

On June 3, the FDA released a revised Emergency Use Authorization (EUA) for Regeneron’s COVID-19 monoclonal antibody combination product casirivimab and imdevimab. The updated EUA includes a new dosing regimen (1200 mg vs. 2400 mg) and allows a new route of administration. In response to this change, CMS created a new HCPCS code, effective June 3, and updated the short and long code descriptors for 2 codes:

New HCPCS Code Q0244:

  • Long descriptor: Injection, casirivimab and imdevimab, 1200 mg
  • Short descriptor: Casirivi and imdevi 1200 mg
  • Price: $0.01

Updated HCPCS Code M0243:

  • Long descriptor: *Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring*
  • Short descriptor: *Casirivi and imdevi inj*
  • Price: $450

Updated HCPCS Code M0244:

  • Long descriptor: *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*
  • Short descriptor: *Casirivi and imdevi inj hm*
  • Price: $750

When the government provides monoclonal antibody products to treat COVID-19 for free, you should only bill for the administration. Don’t include the monoclonal antibody product codes on the claim.

More Information:

 

Men’s Health: Medicare Covers Preventive Services

Medicare covers preventive services, and your patients pay nothing if you accept assignment. During Men’s Health Week, encourage your male patients to make their health a priority.

More Information:

 

Compliance

 

Hospice Care: Safeguards for Medicare Patients

An Office of Inspector General report focused on hospice:

  • Quality of care and common deficiencies
  • Instances of patient harm and vulnerabilities

Review the Safeguards for Medicare Patients in Hospice Care (PDF) fact sheet to recognize and address deficiencies in care and protect your patients from harm. Additional resources:

 

Events

 

HCPCS Public Meeting — Begins July 7

July 7 and 8 (July 9 if needed)

Attend a virtual public meeting for the first 2021 biannual HCPCS coding cycle. Visit the HCPCS Public Meetings webpage for more information, including meeting materials:

 

MLN Matters® Articles

 

Addition of the QW Modifier to Healthcare Common Procedure Coding System (HCPCS) Codes 0240U, 0241U, and 87637

Learn about this change for COVID-19 laboratory service claims (PDF).

 

Quarterly Update for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP) - October 2021

Learn about changes to HCPCS codes, ZIP codes, and single payment amounts (PDF).

 

Quarterly Update to Home Health (HH) Grouper

Learn about annual diagnosis code changes (PDF).

 

July 2021 Quarterly Average Sales Price (ASP) Medicare Part B Drug Pricing Files and Revisions to Prior Quarterly Pricing Files — Revised

Read additional information on Section 405 of the Consolidated Appropriations Act, 2021 (PDF).

 

Publications

 

Medicare Mental Health — Revised

Medicare Mental Health (PDF) Medicare Learning Network booklet: Clarified nurse practitioner coverage requirements.

 

Medicare Secondary Payer — Revised

Medicare Secondary Payer (PDF) Medicare Learning Network booklet: Clarified policy on accepting payment for services if another insurer is primary.

 

Skilled Nursing Facility 3-Day Rule Billing — Revised

Skilled Nursing Facility 3-Day Rule Billing (PDF) Medicare Learning Network fact sheet: Added information on temporary emergency coverage without a qualifying hospital stay due to the COVID-19 public health emergency.

 

Multimedia

 

World of Medicare Web-Based Training — Revised

World of Medicare Medicare Learning Network (MLN) web-based training course: Learn about: 

  • Parts A, B, C, and D
  • Patient eligibility, enrollment, and benefit options
  • Role of providers, agencies, contractors, and organizations
  • Steps to enroll as a Medicare provider

Visit the MLN Web-Based Training webpage for a current list of courses.


Like the newsletter? Have suggestions? Please let us know!

Subscribe to the MLN Connects newsletter. Previous issues are available in the archive.

This newsletter is current as of the issue date. View the complete disclaimer.

Follow the MLN on Twitter #CMSMLN, and visit us on YouTube.

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health and Human Services (HHS).

Medicare Learning Network logo