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Are there new HCPCS codes for the combined COVID-19 pre-exposure prophylactic treatment of tixagevimab and cilgavimab?

Yes.  CMS has announced new HCPCS codes for AstraZeneca’s combined COVID-19 pre-exposure prophylactic treatment Evusheld, which is comprised of tixagevimab and cilgavimab. For your convenience, each code’s long descriptor is listed below. Note, HCPCS Q0220 represents the drug product itself, while M0220 will be reported for infusions provided in a healthcare setting and M0221 reported for infusions provided in the patient’s home.

Q0220: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg

M0220: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring

M0221: Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring in the home or residence; this includes a beneficiary’s home that has been made provider-based to the hospital during the covid-19 public health emergency

It is important to remember that CMS expects when providers receive COVID-19 treatments and vaccines free of charge, providers should only bill for the administration services and not the drug products themselves. For providers whose systems require a product code to bill for the administration, a token charge of $0.01 may be reported for the drug product.

Per the CMS COVID-19 Vaccine and Monoclonal Antibodies homepage, codes Q0220, M0220 and M0221 are retroactively effective back to December 8, 2021 – the same day the FDA issued an emergency use authorization for Evusheld.

Additional resources:

CMS COVID-19 Vaccine and Monoclonal Antibodies homepage:
https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

FDA press release, Coronavirus (COVID-19) Update: “FDA Authorizes New Long-Acting Monoclonal Antibodies for Pre-exposure Prevention of COVID-19 in Certain Individuals”
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-new-long-acting-monoclonal-antibodies-pre-exposure

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