CMS Revises Medicare Payments For COVID-19 Monoclonal Antibody Infusions

CMS Revises Medicare Payments

In a recent development, the Centers for Medicare & Medicaid Services has revised the payment rates for certain COVID-19 antibody infusions. CMS has also introduced a new payment policy for at-home administration. Which will have a higher payment rate as compared to other healthcare settings.

According to an official press release, the national average payment rate for the administration of COVID-19 antibody infusions will increase from $310 to $450 for most healthcare settings.

Moreover, in an attempt to provide financial support to the healthcare practitioners, who are working hard to prevent the spread of deadly viral diseases. CMS is also intending to establish a higher national payment rate of $750. When the monoclonal antibody treatments are administered in a beneficiary’s home.

Regardless of whether these services are being provided at the beneficiary’s permanent residence or temporary lodging. Such as:  hotel/motel, cruise ship, hostel, or homeless shelter.

Furthermore,  beneficiaries are not responsible for any cost-sharing, regardless of where the service is furnished – including in a physician’s office, other healthcare facility or at home.

What’s The Impact?

According to the official statement issued by the CMS: The new payment rates for at-home Infusions accounts for increased costs associated with the one-on-one nature of this care model.

“These higher national average payment rates reflect additional information provided to CMS about the costs of providing these services in a safe and timely manner.  Such as:  clinical staff and personal protective equipment”, it has been added. 

Furthermore, the agency stated that the CMS’s primary objective during the COVID-19 public health emergency is_to ensure complete support to the beneficiary access to care. 

Moreover, “this new policy is based on timely, valuable input from stakeholders including the home health and ambulatory infusion industries on the costs associated with administering monoclonal antibodies.”

It’s worth mentioning here that the US Food and Drug Administration (FDA) has only authorized a few monoclonal antibody products for COVID-19 treatment. Such as: Eli Lilly’s combination bamlanivimab-etesevimab therapy as well as Regeneron Pharmaceuticals’ combination casirivimab-imdevimab therapy.

According to the Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA): these authorized antibody products have helped to reduce symptomatic and severe COVID-19 infection. 

HCPCS Codes For Monoclonal Antibody Billing

Medical practitioners can use the following Healthcare Common Procedure Coding System (HCPCS) codes to bill medicare for COVID-19 monoclonal antibody infusions.

  • M0243: Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring
  • M0244: Intravenous infusion, casirivimab and imdevimab 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.
  • M0245: Intravenous infusion of bamlanivimab and etesevimab and post-administration monitoring
  • M0246: Intravenous infusion of bamlanivimab and etesevimab and post-administration monitoring in a patient’s home or residence, including when a patient’s home has been made provider-based to the hospital during the COVID-19 public health emergency

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