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Effective January 21, 2022, Procedure Code J0248 (Veklury) Is a Benefit

Last updated on 2/14/2022

Note: Texas Medicaid managed care organizations (MCOs) must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, precertification, 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.

Effective for dates of service on or after January 21, 2022, in accordance with the Food and Drug Administration (FDA) emergency use authorization (EUA), procedure code J0248 for administration of Veklury (remdesivir) as a treatment for COVID-19 is now a benefit of Medicaid and the Children with Special Health Care Needs (CSHCN) Services Program in outpatient settings.

Veklury is indicated for patients 12 years of age or older who weigh at least 40 kg, have mild to moderate COVID-19, and are at high risk for progression to severe COVID-19, including hospitalization or death.

Additionally, the FDA has authorized the use of Veklury in pediatric patients weighing 3.5 kg up to 40 kg or pediatric patients 12 years of age or younger weighing at least 3.5 kg who have mild to moderate COVID-19 and are at high risk for progression to severe COVID-19, including hospitalization or death under the EUA.

Veklury administration (procedure code J0248) is restricted to diagnosis code U071.

Administration of Veklury (procedure code J0248) is a benefit of Medicaid and the CSHCN Services Program for the following places of service and provider types:

Place of Service

Provider Type

Office

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

Outpatient Hospital

Hospital

Affected claims with dates of service on or after January 21, 2022, will be reprocessed, and providers may receive additional payment, which will be reflected on future Remittance and Status (R&S) Reports. Providers are not required to appeal the claims unless the claims are denied for additional reasons after reprocessing is complete.

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