The Centers for Medicare and Medicaid Services has released billing codes for Eli Lilly's COVID-19 antibody treatment.
CMS created two billing codes for healthcare providers to receive Medicare payments from administering the antibody cocktail. The first, Q0245, is assigned to 2100 mg injections of bamlanivimab and etesevima. The second, M0245, is to be used for intravenous infusion with post-administration monitoring.
Similar to the COVID-19 vaccine, Medicare will cover these infusions for the duration of the public health emergency.
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When billing CMS for the administration of COVID-19 monoclonal antibody infusions, healthcare providers can file a single claim or by submitting a roster bill.
Because the EUA's administration guidelines are "considerably more complex" than other services, CMS expects providers to use appropriate documentation that shows the guidelines were met, as well as the name of the practitioner who ordered the infusion.
WHY THIS MATTERS
The EUA specifies that the antibody therapy can be used for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. It also designates the therapy to be used only in settings where healthcare providers have immediate access to emergency medical services.
Also of note, while the FDA has granted EUA for bamlanivimab and etesevima to be used together, as well as issuing EUA for bamlanivimab to be administered by itself, etesevima has not been approved for singular use.
The FDA's decision to grant EUA for the Eli Lilly therapy was based on data from the BLAZE-1 and BLAZE-4 trials. Phase 3 of the BLAZE-1 study demonstrated a 70% risk reduction for COVID-19 hospitalizations and death, and results from the BLAZE-4 trial indicated that a 2100 mg dose was similarly effective to a 5600 mg dose, according to Eli Lilly.
THE LARGER TREND
Besides the Eli Lilly antibody treatment, the FDA has also approved the antiviral drug Veklury, also known as remdesivir, for use in adult and pediatric patients 12 years old and older and weighing at least 88 pounds for COVID-19 treatments requiring hospitalization.
When former President Trump was hospitalized with COVID-19, he was given remdesivir, as well as an experimental antibody cocktail being developed by drugmaker Regeneron, in addition to several other drugs, including zinc, vitamin D and the generic version of the heartburn treatment Pepcid.
Regeneron's antibody cocktail, which contains casirivimab and imdevimab, received EUA on November 21, 2020 for the treatment of mild to moderate COVID-19 in adults and for pediatric patients who are at high risk for progressing to severe COVID-19 and/or hospitalization.
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