Audience: Physicians, Hospitals, Infusion Centers, Skilled Nursing Facilities and Home Health Care Providers
The U.S. Food and Drug Administration issued an emergency use authorization for investigational monoclonal antibody therapies bamlanivimab and casirivimab/imdevimab for the treatment of mild-to-moderate coronavirus disease 2019 (COVID-19) in adult and pediatric patients.
We encourage you to review the FDA fact sheets (links below) for additional details, including authorized use, limitations, administration guidelines, contraindications and more.
The following information provides billing, reimbursement and member cost-share details for COVID-19 antibody therapy provided to Excellus BlueCross BlueShield (BCBS) members.
Member Cost-Share Responsibility; Reimbursement Information
The initial supply of COVID-19 monoclonal antibodies will be provided free of charge by the federal government. Providers should not bill for the monoclonal antibody products they receive for free. Excellus BCBS will provide reimbursement for infusion of the antibody treatments only. When the federal government stops paying for monoclonal antibody products, we will communicate any billing changes as they become available.
- For the Medicare Advantage line of business/products, the Centers for Medicare & Medicaid Services (CMS) announced that, beginning November 10, 2020, Medicare beneficiaries can receive coverage of monoclonal antibodies to treat mild-to-moderate COVID-19 with no cost-sharing during the public health emergency. Claims for infusion services should be billed directly to Medicare fee-for-service through December 31, 2021. Medicare fee-for-service will reimburse providers directly during this time frame.
- For HMOBlue Option, Blue Choice Option, Premier Option, Blue Option Plus, Premier Option Plus and Healthy NY, Excellus BCBS will mirror New York State Medicaid rates for monoclonal antibody administration. When NYS Medicaid does not have an established rate, Excellus BCBS will use the reimbursement rate used by CMS. Medicaid out-of-network providers must be participating with fee-for-service, even if not participating with Excellus BCBS, to be reimbursed for these antibody treatments.
- Child Health Plus and Essential Plan will follow standard coverage/benefit guidelines and reimbursement methodology for this treatment.
- For all other products and lines of business, Excellus BCBS will mirror Medicare reimbursement rates established by CMS and we will waive cost-share both in-network and out-of-network in accordance with our existing decision to waive cost-share for COVID-19 treatment services through the expiration of the New York State of Emergency. This decision also applies to those self-funded, Article 47 and Minimum Premium groups that have opted in. Claims for infusion services should be billed directly to Excellus BCBS.
The following CPT® codes must be used when billing COVID-19 monoclonal antibody administration:
Code Description Rate
M0239: bamlanivimab infusion $309.60
M0243: casirivimab and imdevimab infusion $309.60
If you have any questions regarding this information, please contact your Provider Relations representative.Email this article