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Additional Diagnosis Code for Monoclonal Antibody Therapy Administration Code M0243

Last updated on 9/7/2021

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 July 30, 2021, the FDA revised the emergency use authorization (EUA) for REGEN-COV (casirivimab and imdevimab, administered together) authorizing REGEN-COV for emergency use as post-exposure prophylaxis (prevention) for COVID-19 in adults and pediatric individuals (12 years of age or older weighing at least 40kg) who are at high risk for progression to severe COVID-19, including hospitalization or death. 

Effective for dates of service on or after July 30, 2021, diagnosis code Z20822, indicating possible exposure to COVID-19, will be added as a payable diagnosis for procedure code M0243 for monoclonal antibody therapy administration.

Affected claims submitted with dates of service from July 30, 2021, through August 12, 2021, will be reprocessed. Providers may receive an additional payment, which will be reflected on future Remittance and Status Reports.

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