Effective with date of service Feb. 15, 2022, the Medicaid and NC Health Choice programs cover bebtelovimab injection for intravenous use in the Physician Administered Drug Program (PADP) when billed with HCPCS code Q0222 - Injection, bebtelovimab, 175 mg.
Strength/Package Size(s): Injection: 175 mg/2 mL (87.5 mg/mL) in a single-dose vial
EMERGENCY USE AUTHORIZATION
The U.S. Food and Drug Administration (FDA) has issued an Emergency Use Authorization (EUA) for the emergency use of bebtelovimab for the treatment of mild to moderate coronavirus disease 2019 (COVID-19) in adults and pediatric patients (age 12 and older weighing at least 40 kg):
- with positive results of direct SARS-CoV-2 viral testing
- who are at high risk for progression to severe COVID-19, including hospitalization or death
- for whom alternative COVID-19 treatment options approved or authorized by FDA are not accessible or clinically appropriate.
Limitations of Authorized Use
- Bebtelovimab is not authorized for treatment of mild-to-moderate COVID-19 in geographic regions where infection is likely to have been caused by a non-susceptible SARS-CoV-2 variant based on available information including variant susceptibility to this drug and regional variant frequency.
- Bebtelovimab is not authorized for use in patients who:
- are hospitalized due to COVID-19 OR
- require oxygen therapy and/or respiratory support due to COVID-19, OR
- require an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID19 related comorbidity.
Bebtelovimab is authorized only for the duration of the declaration that circumstances exist justifying the authorization of the emergency use of bebtelovimab under section 564(b)(1) of the Act, 21 U.S.C. § 360bbb-3(b)(1), unless the authorization is terminated or revoked sooner.
Recommended Dose: 175 mg administered as a single intravenous injection over at least 30 seconds. See full prescribing information for further detail.
For Medicaid and NC Health Choice Billing
- The ICD-10-CM diagnosis code(s) required for billing is/are:
- U07.1 - COVID-19
- B34.2 - Coronavirus infection, unspecified
- B97.21 - SARS-associated coronavirus as the cause of diseases classified elsewhere
- J12.81 - Pneumonia due to SARS-associated coronavirus
- Providers must bill with HCPCS code Q0222 - Injection, bebtelovimab, 175 mg
- One Medicaid and NC Health Choice unit of coverage is: 175 mg
- The maximum reimbursement rate per unit is: N/A
- Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs is: 00002-7589-01
- The NDC units should be reported as "UN1"
- For additional information, refer to the January 2012, Special Bulletin, National Drug Code Implementation Update.
- For additional information regarding NDC claim requirements related to the PADP, refer to the PADP Clinical Coverage Policy 1B, Attachment A, H.7 on DHB's website.
- The fee schedule for the PADP is available on DHB's PADP web page.
Additional information
- When MAB doses are provided by the government without charge, providers should only bill for the administration.
- Administration codes to use:
- M0222 - Intravenous injection, bebtelovimab, includes injection and post administration monitoring
- M0223 - Intravenous injection, bebtelovimab, includes 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
- Rates for administration of the MABs can be found on specific provider fee schedules.
- Outpatient hospital claims should be filed with RC 277 and the appropriate HCPCS code
CONTACT
NCTracks Contact Center: 800-688-6696