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COVID-19 Monoclonal Antibody Administration Procedure Codes M0222, M0223, and Q0222 for COVID-19 Now a Benefit

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Note: Texas Medicaid and CHIP managed care organizations (MCOs) must provide all medically necessary 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), CHIP, and from MCO to MCO. Providers should contact the client's specific MCO for details.

Effective for dates of service on or after February 11, 2022, procedure codes M0222 and M0223 are a benefit of Texas Medicaid, CHIP, and the Children with Special Health Care Needs (CSHCN) Services Program for the administration of Eli Lilly’s bebtelovimab monoclonal antibody therapy for the treatment of COVID-19. Procedure code M0222 is for administration of Eli Lilly’s bebtelovimab in a health-care setting, and M0223 is for administration of Eli Lilly’s bebtelovimab in the home or residence. 

Effective for dates of service on or after February 11, 2022, procedure code Q0222 for bebtelovimab monoclonal antibody therapy is a benefit of Texas Medicaid, CHIP, and the CSHCN Services Program and has been added as informational while the drug is being distributed free of charge.

      The U.S. Food and Drug Administration (FDA) has issued an Emergency Use
      Authorization (EUA) for the emergency use of bebtelovimab for the treatment
      of mild to moderate coronavirus disease 2019 (COVID-19) in adults and
      pediatric patients (age 12 and older weighing at least 40 kg):

  • with positive results of direct SARS-CoV-2 viral testing
  • who are at high risk for progression to severe COVID-19, including hospitalization or death
  • for whom alternative COVID-19 treatment options approved or authorized by FDA are not accessible or clinically appropriate

Limitations of Authorized Use

Bebtelovimab is not authorized for treatment of mild to moderate COVID-19 in geographic regions where infection is likely to have been caused by a non-susceptible SARS-CoV-2 variant based on available information including variant susceptibility to this drug and regional variant frequency.

Bebtelovimab is not authorized for use in patients who:

  • Are hospitalized due to COVID-19 OR
  • Require oxygen therapy and/or respiratory support due to COVID-19, OR
  • Require an increase in baseline oxygen flow rate or respiratory support due to COVID-19 and are on chronic oxygen therapy or respiratory support due to underlying non-COVID19 related comorbidity.

Procedure code M0222 is a benefit for the following providers and places of service:

Medicaid

Place of Service

Provider Type

Office

Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist

Nursing Home (SNF/ICF and ECF)

Physician, Physician Groups

Outpatient Hospital

Hospital Providers

CSHCN Services Program

Place of Service

Provider Type

Office

Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist

Outpatient Hospital

Hospital Providers

Procedure code M0223 is a benefit for the following providers and places of service:

Medicaid, CHIP, and the CSHCN Services Program

Place of Service

Provider Type

Home

Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Home Health Agency, Comprehensive Care Program (CCP) Providers

Procedure codes M0222 and M0223 must be billed with diagnosis code U071.

Note: Procedure codes M0222 and M0223 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 1-800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 1-800-568-2413.