CMS created the new HCPCS code C9507 for COVID-19 convalescent plasma for use in the outpatient setting. This code is effective for dates of service on or after December 28, 2021, when administered in an outpatient setting. CMS released this information in the MLN Connects newsletter for Thursday, February 10, 2022.
On December 28, 2021, the FDA revised the emergency use authorization for COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. It’s authorized for treatment of COVID-19 in patients with immunosuppressive disease or getting immunosuppressive treatment, in the outpatient or inpatient setting.
Code C9507 is available for use in the outpatient setting for dates of service on or after December 28, 2021.
We are providing the following guidance for billing C9507 to prevent impacts to your claims processing.
Submit claims with:
HCPCS code: C9507
Long descriptor: Fresh frozen plasma, high titer COVID-19 convalescent, frozen within 8 hours of collection, each unit
Short descriptor: COVID-19 convalescent plasma
Status Indicator (SI) and APC:
12/28/2021 - 3/31/2022: SI "S" and APC 1509
Effective 4/1/2022: SI "R" and APC 9540
Appropriate diagnosis coded to highest level of specificity
Appropriate type of bill:
12x, 13x, or 85x
Appropriate revenue code:
0383, 0390 or 0392
Payment rate:
2022 $750.50 per unit
2023 $729.81 per unit
Beneficiary cost sharing will apply to COVID-19 convalescent plasma product code.
Billing and payment information can be found on the Hospital Outpatient PPS webpage and see Addenda B on the OPPS Addendum A and Addendum B Updates webpage.
Please visit our Coronavirus (COVID-19) webpage for additional information about the public health emergency.
Loading...
