2023 COVID-19 monoclonal antibodies reimbursement

Medicare will pay a national payment rate for many providers. These rates will also be geographically adjusted for many providers. For providers and suppliers with payments that are geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), the geographically adjusted payment rates for monoclonal antibody administration are listed below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

Use the chart below to determine how your facility is reimbursed.

Facility	Type of bill	Payment
Hospitals, other than Indian health services (IHS) hospitals and critical access hospitals (CAHs).	012x, 013x	Outpatient prospective payment system (OPPS) for hospitals subject to OPPS. Reasonable cost for hospitals not subject to OPPS.
IHS hospitals	012x, 013x, 083x	MPFS
IHS CAHs	085x	MPFS
CAHs Method I and II	085x	Reasonable cost
Skilled nursing facilities	022x, 023x	MPFS
Comprehensive outpatient rehabilitation facility	075x	MPFS
Independent renal dialysis facilities (RDFs)	072x	MPFS
Hospital-based RDFs	072x	Reasonable cost

Billable TOBs notes:

HCPCS Q0240, M0240, M0241, M0244, M0246, and M0248 billable only on the following TOBs: 13X, 22X, 23X, 34X, 72X, 75X, 81X, 82X and 85X.

HCPCS Q0249, M0249 and M0250 are billable on TOB 12X (inpatient hospital only).

HCPCS Q0220, M0220, and M0221 billable on the following TOBs: 12X, 13X, 22X, 23X, 34X, 72X, 75X, 81X, 82X and 85X.

COVID-19 monoclonal antibodies fees

*Initially, CMS anticipates that providers will not incur a cost for these mAb products. CMS will update the payment allowance at a later date. Providers should not bill for the product if they received it for free.

Code	Vaccine/Procedure name	Payment allowance
Q0220	Injection, tixagevimab and cilgavimab, 300 mg	$0.010*
Q0221	Injection, tixagevimab and cilgavimab, 600 mg	$0.010*
Q0222***	Injection, bebtelovimab, 175 mg	$0.010*
Q0239**	Injection, bamlanivimab, 700 mg **Code not active during this time period	$0.010*
Q0240	Injection, casirivimab and imdevimab, 600 mg	$0.010*
Q0243	Injection, casirivimab and imdevimab, 2400 mg	$0.010*
Q0244	Injection, casirivimab and imdevimab, 1200 mg	$0.010*
Q0245	Injection, bamlanivimab and etesevimab, 2100 mg	$0.010*
Q0247	Injection, sotrovimab, 500 mg	$2394.00
Q0249	Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg.	$6.572

COVID-19 monoclonal antibodies administration fees

CMS has identified specific codes for the COVID-19 monoclonal antibody administration codes.

Note: Administration includes infusion and post administration monitoring.

Code	Vaccine/procedure name	National payment allowance
M0220	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), includes injection and post administration monitoring.	$150.50
M0221	Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s), 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.	$250.50
M0222	Intravenous injection, bebtelovimab, includes injection and post administration monitoring	$350.50
M0223	Intravenous injection, bebtelovimab, 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	$550.50
M0239**	Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring.	**Code not active during this time period
M0240	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses.	$450.00
M0241	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 (PHE), subsequent repeat doses.	$750.00
M0243	Intravenous infusion or subcutaneous injection, casirivimab and imdevimab, includes infusion or injection, and post administration monitoring.	$450.00
M0244	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 PHE.	$750.00
M0245	intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring.	$450.00
M0246	Intravenous infusion, bamlanivimab and etesevimab, 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 PHE.	$750.00
M0247	Intravenous infusion, sotrovimab, includes infusion and post administration monitoring.	$450.00
M0248	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 PHE.	$750.00
M0249	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, first dose	$450.00
M0250	Intravenous infusion, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with COVID-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, includes infusion and post administration monitoring, second dose.	$450.00

***Q0222 - Eli Lilly started commercial distribution on August 15. For dates of service on or after August 15, claims for commercially acquired treatments may be allowed at the new payment rate of $2,394.00. You may have supplies of both the United States Government (USG)-procured and commercially procured product. Providers should only bill above a nominal amount for the commercially procured product. You can identify the commercially-procured vials by the batch number D534422 and other batch numbers will be issued. Review the batch number prior to claim submission to determine if the product was USG procured or commercially procured and ensure appropriate billing.

Jurisdiction L

State	Locality	Admin reim M0220	Admin reim M0221	Admin reim M0222	Admin reim M0223	Admin reim M0240 M0243 M0245 M0247 M0249 M0250	Admin reim M0241 M0244 M0246 M0248
Delaware	Entire state (01)	$151.10	$251.50	$351.90	$552.70	$451.80	$753.00
DC Metro	DC + MD/VA suburbs (01)	$170.82	$284.32	$397.82	$624.82	$510.75	$851.25
Maryland	Baltimore/surr. cntys (01)	$160.28	$266.78	$373.28	$586.28	$479.25	$798.75
	Rest of Maryland (99	$153.36	$255.26	$357.16	$560.96	$458.55	$764.25
New Jersey	Northern New Jersey (01)	$167.51	$278.81	$390.11	$612.71	$500.85	$834.75
	Rest of New Jersey (99)	$162.09	$269.79	$377.49	$592.89	$484.65	$807.75
Pennsylvania	Metropolitan Philadelphia (01)	$158.03	$263.03	$368.03	$578.03	$472.50	$787.50
	Rest of Pennsylvania (99)	$145.23	$241.73	$338.23	$531.23	$434.25	$723.75

Jurisdiction H

State	Locality	Admin reim M0220	Admin reim M0221	Admin reim M0222	Admin reim M0223	Admin reim M0240 M0243 M0245 M0247 M0249 M0250	Admin reim M0241 M0244 M0246 M0248
Arkansas	Entire state (13)	$137.26	$228.46	$319.66	$502.06	$410.40	$684.00
Colorado	Entire state (01)	$153.06	$254.76	$356.46	$559.86	$457.65	$762.75
Louisiana	New Orleans (01)	$147.94	$246.24	$344.54	$541.14	$442.35	$737.25
	Rest of Louisiana (99)	$142.98	$237.98	$332.98	$522.98	$427.50	$712.50
Mississippi	Entire state (00)	$138.31	$230.21	$322.11	$505.91	$413.55	$689.25
New Mexico	Entire state (05)	$144.78	$240.98	$337.18	$529.58	$432.90	$721.50
Oklahoma	Entire state (00)	$141.47	$235.47	$329.47	$517.47	$423.00	$705.00
Texas	Austin (31)	$152.46	$253.76	$355.06	$557.66	$455.85	$759.75
	Beaumont (20)	$143.73	$239.23	$334.73	$525.73	$429.75	$716.25
	Brazoria (09)	$151.10	$251.50	$351.90	$552.70	$451.80	$753.00
	Dallas (11)	$151.10	$251.50	$351.90	$552.70	$451.80	$753.00
	Fort Worth (28)	$149.45	$248.75	$348.05	$546.65	$446.85	$744.75
	Galveston (15)	$151.25	$251.75	$352.25	$553.25	$452.25	$753.75
	Houston (18)	$154.26	$256.76	$359.26	$564.26	$461.25	$768.75
	Rest of Texas (99)	$145.53	$242.23	$338.93	$532.33	$435.15	$725.25

References

Jan-Dec 2023 Geographically-adjusted payment rates for monoclonal antibody administration (for providers & suppliers paid MPFS-adjusted rates) (ZIP) (For claims with dates of services 01/01/2023 through 12/31/2023)

Person(s) with Medicare

Corporate Site