New HCPCS Codes for COVID-19 Treatment Introduced

The rates for administration will be adjusted for geographic location.

While we are waiting for the tentative agenda for the PCS codes presentation for the Coordination and Maintenance Committee Meeting hosted by the Centers for Medicare & Medicaid Services (CMS), I thought that I would perhaps change gears and report on new codes.

Usually we talk about ICD-10 on ICD10monitor, but this article will center on new HCPCS codes. CMS has released HCPCS codes for a drug and drug administration for the treatment of COVID-19’s Omicron variant. The treatment is bebtelovimab, which was authorized on Feb. 11 by the Food and Drug Administration (FDA) for emergency use to treat patients who are at high risk to progress to severe COVID-19 or hospitalization. The patient must have a positive COVID-19 test to qualify. This drug is assigned Q0222, with the description of injection, bebtelovimab, 175 milligrams. The administration of the medication is assigned M0222 (intravenous injection, bebtelovimab, including injection and post-administration monitoring) or M0223 (intravenous injection, bebtelovimab, including injection and post-administration monitoring in the home or residence).

The national payment rate for the three codes are as follows:

         M0222 – $350.50

         M0223 – $550.50

         Q0222 – $    0.01

Remember that providers will not initially incur a cost for the product. The rates for administration will be adjusted for geographic location.

This information can be found on the CMS website, under Part B Drug Average Sales Price and select COVID-19 Vaccines and Monoclonal Antibodies. Another resource is the MLN Connects edition dated Feb. 18, 2022.

These three codes are the most recent edition to the CPT® codes for the treatment of COVID-19. The American Medical Association (AMA) has a resource that provides all the CPT codes that are related to COVID-19 treatment. The COVID-19 CPT codes have been released continuously following the advent of the pandemic. This listing can be a wonderful resource to remain up to date on the CPT releases. A link is provided at the end of this article.

Additionally, the Centers for Disease Control and Prevention (CDC) has some wonderful resources on COVID-19. There is the CDC Learning Connection, which provides information on trainings and resources for healthcare professionals.

There is a webinar that centers on Multisystem Inflammatory System (MIS), which is a condition that has been related to COVID-19 and primarily affects children. There is a webinar for community-based organizations to discuss COVID-10 testing. There is also a podcast that discusses the data challenges during the pandemic.

The CDC site also has information regarding the data modernization initiative (DMI). The DMI was launched in 2020, and is an effort to modernize core data and surveillance infrastructure across the federal and state public health landscape.

AMA COVID CPT Code Listing: HTTPS://WWW.AMA-ASSN.ORG/PRACTICE-MANAGEMENT/CPT/COVID-19-CPT-CODING-AND-GUIDANCE

Programming Note: Listen to Laurie Johnson and her Coding Report every Tuesday on Talk Ten Tuesdays, 10 Eastern.