Has CMS announced new HCPCS codes for prophylactic use of casirivimab and imdevimab?

Yes. On August 30, 2021, CMS announced the release of 3 new codes related to the administration casirivimab and imdevimab combined.  One code is for the drug product and two codes are for administration services.  The long descriptors are as follows:

  • Q0240: Injection, casirivimab and imdevimab, 600 mg
  • M0240: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses
  • M0241: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or 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, subsequent repeat doses

The effective date of these codes will be back dated to July 30, 2021 which is the date the FDA revised the emergency use authorization to allow the use of the combined casirivimab and imdevimab product for preventive purposes for certain patients who have been exposed to (or are at high risk of exposure to) a person with COVID-19.

Be advised that since the codes were only recently released, it may take time before insurers are able to process claims with these new codes.

Resources:

CMS is providing payment information for the new codes on their COVID-19 vaccines and monoclonal antibodies webpage at:
https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies