Monoclonal Antibody Infusion Billing: What We Know So Far

CMS has approved monoclonal antibody infusion treatment for patients with mild to moderate COVID-19 who are at risk for progressing to severe COVID-19. There are three options: bamlanivimab- approved November 9, 2020, casirivimab and imdevimab- approved November 21, 2020 and bamlanivimab and etesevimab- approved February 9, 2021. Below are the procedure codes you should use.

Eli Lilly and Company's Antibody Bamlanivimab (LY-CoV555):

• Q0239- Injection, bamlanivimab-xxxx, 700 mg

• M0239- intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring

Regeneron's Antibody casirivimab and imdevimab (REGN-COV2):

• Q0243- Injection, casirivimab and imdevimab, 2400 mg

• M0243- intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring

Eli Lilli and Company's Bamlanivimab and Etesevimab:

• Q0245- Injection, bamlanivimab and etesevimab, 2100 mg

• M0245- intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring

The diagnosis codes for all of these should be Z23, followed by U07.1. The Medicare national average payment rate for the medication and infusion combined is around $310, however, providers should not bill for medication that was provided to them at no cost. One other item to note- you should bill Medicare directly even if the patient has a Medicare Advantage Plan.

I billed out for the Bamlanivimab in Massachusetts. I used CPT code M0239, diagnosis codes Z23 and U07.1 and put a fee of $350 to ensure I captured the full payment. Medicare, however, allowed and paid the full amount. This goes against their statement that payment will be approximately $310. I am going to raise the fee in the next billing to test, but I am expecting Medicare will do a take back at some point. I will update this when I have a solid answer. With new codes, it sometimes takes insurances a little while to update their software so claims are paid correctly; trial and error at this point.

**UPDATE** Medicare in Massachusetts is allowing and paying $368.45 so make sure your fee is higher than that.

If you need more guidance or have any questions regarding this infusion billing, please reach out!

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