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Monoclonal Antibody Administration Procedure Codes M0220 and M0221 for COVID-19 Now a Benefit

Last updated on 1/26/2022

Effective for dates of service on or after December 8, 2021, procedure codes M0220 and M0221 are a benefit of Texas Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program for the administration of AstraZeneca’s Evusheld (tixagevimab co-packaged with cilgavimab) monoclonal antibody therapy for COVID-19 pre-exposure prophylaxis to prevent COVID-19 in adults and pediatric individuals (12 years of age or older and weighing at least 40kg). Procedure code M0220 is for administration of AstraZeneca’s Evusheld in a health-care setting, and M0221 is for administration in the home or residence.

Effective for dates of service on or after December 8, 2021, procedure code Q0220 for Evusheld monoclonal antibody therapy is a benefit of Texas Medicaid and the CSHCN Services Program and has been added as informational while the drug is being distributed to providers free of charge.

The Food and Drug Administration (FDA) has authorized the use Evusheld for pre-exposure prophylaxis for certain adults and pediatric individuals (age 12 or older and weighing at least 40kg):

  • Who are not currently infected with SARS-CoV-2 and who have not had known recent exposure to an individual infected with SARSCoV-2 and
  • Who have moderate to severe immune compromise because of a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination or
  • For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended because of a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID19 vaccine component(s).

Procedure code M0220 is a benefit for the following providers and places of service:

Place of Service

Provider Types

Nursing Home

Physician, Clinic/Group Practice

Office

Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Group, Clinic/Group Practice

Outpatient Hospital

Hospital

Procedure code M0221 is a benefit for the following providers and places of service:

Place of Service

Provider Types

Home

Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Group, Clinic/Group Practice, Home Health Agency, CCP Provider

Procedure codes M0220 and M0221 must be billed with diagnosis code Z20822.

Note: Procedure codes M0220 and M0221 will not be reimbursed until expenditures are approved and the rates are adopted by Texas Medicaid. 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.