CMS Released Billing Codes for COVID-19 Antibody

Medical billing services have always been an important part of the healthcare industry. Also, with the corona pandemic, these services are now crucial to run the revenue cycle.

COVID-19 has tested our every ability, and our healthcare industry is coping with the surge of patients with limited resources. Meanwhile, where there are other administrative issues, CMS (Centers for Medicare and Medicaid Services) is facilitating on the medical billing and coding front.

The New Update about the COVID Antibody

Most of you must know that COVID-19 antibodies would be officially available for everyone from next year. Tests have been running, and vaccine shots are being injected into a group of people to create awareness. To administer the process of medical billing services, CMS released two new codes to document antibodies.

Under the HCPCS (Healthcare Common Procedural Coding System), now physicians can use the following codes:

• Q0243 for the injection of 2,400 milligrams of Regeneron’s investigational monoclonal antibody therapy cocktail
• M0243 for intravenous infusion and post-administration monitoring

The new codes reflect on the investigational monoclonal antibody therapy from Regeneron. FDA approved this therapy, and it is authorized for the mild-to-moderate COVID-19 patients with a chance of hospitalization.

Instructions from CMS

CMS has instructed healthcare service providers and medical billing services that as long as they document antibodies as per the guidelines, Medicare will pay for them. Moreover, the payment program will also reimburse medical practices for the other infusions the way they do for COVID-19 vaccines.

The payment allowances for the COVID injections have already been in effect since November 21. CMS further explains that the reimbursement for initial injection is low mostly because physicians do not expect to bear the cost for Regeneron’s therapy.

Initial Antibody Doses are Free

HHS (United States Department of Health and Human Services) is already providing the initial antibodies for free (as per the COVID infected population in each region). Regeneron has signed a contract with the pharmaceutical companies to distribute between 70,000 and 300,000 doses all over the states.

CMS also has mentioned that Medicare will not reimburse for any of the government-allotted free antibody doses. However, they will inform (physicians & medical billing services) beforehand when physicians can expect to bear the expenses.

Conclusion

The therapies are expected to overcome the potential patient visits to hospitals. Moreover, their Medicare coverage will ease the process of COVID treatment, and medical billing services can better cater to physicians’ finances. Having said that, the healthcare industry is expected to face hurdles against adequate access to antibodies.