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 February 24, 2022, procedure code Q0221 for AstraZeneca Evusheld (tixagevimab co-packaged with cilgavimab) monoclonal antibody therapy, for COVID-19 pre-exposure prophylaxis to prevent COVID-19 in adults and pediatric patients 12 years of age or older and weighing at least 40 kg, is a benefit of Texas Medicaid, the Children’s Health Insurance Program (CHIP), and the Children with Special Health Care Needs (CSHCN) Services Program. The Food and Drug Administration (FDA) revised the emergency use authorization (EUA) for Evusheld™ to change the initial dose. Originally, the recommended dosage was 150 mg of tixagevimab and 150 mg of cilgavimab, for a total of 300 mg, but because of decreased neutralization activity against certain COVID-19 subvariants, the initial dose has been increased to 300 mg of tixagevimab and 300 mg of cilgavimab, for a total of 600 mg.
Procedure code Q0221 has been added as informational while the drug is being distributed to providers free of charge.
The FDA has authorized the use of Evusheld for preexposure prophylaxis for certain adults and pediatric individuals age 12 or older and weighing at least 40 kg who are not currently infected with SARS-CoV-2 and who have not had known recent exposure to an individual infected with SARS-CoV-2 AND
- 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 or COVID-19 vaccine components.
Procedure code M0220 (administration of Evusheld in a long-term care facility, office, or outpatient hospital) can be billed with procedure code Q0221.
Procedure code M0221 (administration of Evusheld inside a patient’s home) can be billed in the home setting with procedure code Q0221.
For more information, call the TMHP Contact Center at 800-925-9126 or the TMHP-CSHCN Services Program Contact Center at 800-568-2413.