In January 2020, a public health emergency (PHE) was declared as COVID-19 spread around the world. Since the start of this pandemic, the monoclonal antibody (mAb) products and administration have been assigned a variety of new HCPCS Level II codes. Unfortunately, this has caused some confusion within the medical industry around codes and billing. However, confusion has been spread further with the latest billing changes to the mAb infusions for Medicare Advantage (MA) patients and COVID-19 vaccines.
Coding for Covid-19 Vaccines
It was revealed that as of January 1, 2022, the COVID-19 vaccines and mAbs would no longer be paid for by Original Medicare, and instead, should be directly billed to and reimbursed by the recipient's MA plan. This does not apply to patients in MA hospice care but does exclude the MA plans engaged in the Hospice Benefit Component of the Value-Based Insurance Design Model. Providers have been advised to include the latest condition codes and coverage updates within the contracts.
These are important changes that healthcare providers must know, or else it will result in claims denials, which unfortunately has been the case for many people who were not aware of the latest changes. There are a variety of codes for monoclonal antibody therapies that have emergency use authorization (EUA) that should also be regularly reviewed.
Additional Resources
If you are a medical practice, you must be informed with the latest updates, so that you know and fully understand what you need to do under the circumstances and the correct billing codes for COVID-19 monoclonal antibody treatments. Here you can find a useful resource for more information.