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Addition of Procedure Codes Q0245 and M0245 Approved for the Treatment of COVID-19 through Emergency Use Authorization

Last updated on 3/16/2021

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims/encounter data filing may differ from traditional Medicaid (fee-for-service) and from MCO to MCO. Providers should contact the client's specific MCO for details.

On February 9, 2021, the U.S. Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the monoclonal antibody therapy, bamlanivimab and etesevimab, for the treatment of mild-to-moderate COVID-19. Effective for dates of service on or after February 9, 2021, procedure codes Q0245 (bamlanivimab and estesvimab) and M0245 (administration of for bamlanivimab and estesvimab) have been added for Texas Medicaid.

Procedure code Q0245 is informational only while being distributed to providers free of charge.

Note: Bamlanivimab may only be administered in settings in which health- care providers have immediate access to medications to treat a severe infusion reaction, such as anaphylaxis, and the ability to activate the emergency medical system (EMS), as necessary.

Procedure code M0245 is a benefit for clients who are 12 years of age and older, weigh at least 40kg, and restricted to diagnosis code U071.

Procedure code M0245 is a benefit for the following providers and places of service:

Place of Services

Provider Type


Physician assistant, nurse practitioner, clinical nurse specialist, physician (D.O), physician (M.D.), physician group (D.O.s only), clinic/group practice

Outpatient hospital

Hospital (long-term, limited, or specialized care), hospital (private full care), hospital (private, outpatient service, emergency care only)

Nursing home – skilled nursing facility/intermediate care facility (SNF/ICF)

Physician (D.O), physician (M.D.), physician group (D.O.s only), clinic/group practice

Nursing home – extended care facility (ECF)

Physician (D.O), physician (M.D.), physician group (D.O.s only), clinic/group practice

Note: Procedure codes Q0245 and M0245 will not be reimbursed until expenditures are approved and Texas Medicaid adopts the rates. Providers will be notified of any benefit changes in a future article.

Services provided before the expenditures are approved will receive the following explanation of benefits (EOB) 02008 notification, “This procedure code has been approved as a benefit pending the approval of expenditures. Providers will be notified of the effective dates of service in a future notification if expenditures are approved.”

For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.