Article Detail - JE Part A
COVID-19 Monoclonal Antibody Therapy Q0222 Injection, Bebtelovimab, 175 mg Payment Allowance Update
On August 15, drug manufacturer, Eli Lilly, will start commercial distribution of their COVID-19 monoclonal antibody therapy, bebtelovimab, 175 mg. CMS will pay 95% average wholesale price (AWP) or $2394.00 for this product.
You might have both United States Government (USG)-purchased and commercial product in your inventory. For dates of service on or after August 15, only bill Medicare if you use commercially purchased products; don’t bill for USG-purchased products. Continue to bill for administering either type of product.
Check the Batch # on the vial. If the Batch # is D534422, the product was commercially purchased. Watch for Eli Lilly to release more information about future batch numbers.
Continue to use the HCPCS codes from the CMS Vaccine Pricing webpage:
- Q0222: Injection, 175 mg for the product
- M0222: Intravenous injection, includes injection and post administration monitoring
- M0223: Intravenous injection, 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
There’s no cost sharing (no copayment/coinsurance or deductible) through the calendar year that the COVID-19 public health emergency ends for monoclonal antibody therapies to treat COVID-19 for people with Medicare.
Source: CMS MLN Connects dated August 11, 2022
Last Updated Tue, 14 Nov 2023 17:37:22 +0000