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Has CMS increased the reimbursement rate it will pay providers for COVID-19 monoclonal antibody infusion services?

Yes. Through an MLN Connects Special Edition bulletin, CMS announced that effective May 6, 2021, it will be increasing the reimbursement rate paid to providers for COVID-19 monoclonal antibody infusion services from roughly $310 on average, to around $450. Also beginning May 6, 2021, CMS states it will now reimburse providers a rate of around $750 when COVID-19 monoclonal antibody treatments are administered in the beneficiary’s home.

CMS has updated its COVID-19 Vaccines and Monoclonal Antibodies homepage to include two new HCPCS codes to describe home infusion services of Casirivimab/Imdevimab and Bamlanivimab/Etesevimab. We have provided the long descriptions for the two new administration codes below for your convenience. It is important to note, these new HCPCS codes should only be reported if the infusions are provided in the patient’s home. HCPCS codes M0243 and M0245 should continue to be used respectively, when the infusions are provided in the facility/clinic/office setting.

M0244: Intravenous infusion, casirivimab and imdevimab includes infusion 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.

M0246: Intravenous infusion, bamlanivimab and etesevimab, includes infusion 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 note, CMS has not yet released a corrected Addendum B file that reflects the new payment rates outlined within the MLN Connects Special Edition. Therefore, there may be a delay in MACs implementing these new rates. We recommend providers track claims for these services closely over the coming weeks. We will provide updates if and when they are released by CMS.

CMS MLN Connects Special Edition, “CMS Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions”:
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-05-06-mlnc-se

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