NOTICES
DEPARTMENT OF HUMAN SERVICES
Updates to the Medical Assistance Program Fee Schedule for Administration of SARS-CoV-2 Monoclonal Antibody Products
[52 Pa.B. 1697]
[Saturday, March 19, 2022]
In accordance with 55 Pa. Code § 1150.61(a) (relating to guidelines for fee schedule changes), the Department of Human Services (Department) announces that it increased fees in the Medical Assistance (MA) Fee Schedule for the administration of SARS-CoV-2 monoclonal antibody products in the Fee-for-Service delivery systems for the Current Procedural Terminology (CPT) codes identified as follows, effective for dates of service on and after May 6, 2021. The Department also announces that it end-dated procedure code M0239, effective April 16, 2021.
Procedure
Code | Description | Old
MA Fee | New
MA Fee |
|---|
| M0243 | Intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring | $247.68 | $360 |
| M0245 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring | $247.68 | $360 |
Additionally, the Department announces the addition of the following CPT codes to the MA Program Fee Schedule for the administration of SARS-CoV-2 monoclonal antibody products for treatment of the SARS-CoV-2. The effective date and MA Fee for each code is indicated as follows.
Procedure
Code | Description | Effective
Date | MA Fee |
|---|
| M0220 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known SARS-CoV-2 exposure, who either have moderate to severely compromised immune systems or for who vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccines and/or COVID-19 vaccine components, includes injection and post administration monitoring | 12/8/21 | $120.40
|
| M0221 | Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known SARS-CoV-2 exposure, who either have moderate to severely compromised immune systems or for who vaccination with any available COVID-19 vaccine is not recommended due to a history of severe adverse reaction to a COVID-19 vaccines or COVID-19 vaccine components, or both, 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 | 12/8/21 | $200.40
|
| M0240 | Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection and post administration monitoring, subsequent repeat doses | 7/30/21 | $360 |
| 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 | 7/30/21 | $600 |
| M0244 | 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 | 5/6/21 | $600 |
| M0246 | Intravenous infusion, bamlanivimab and etesevimab, includes infusion 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 | 5/6/21 | $600 |
| M0247 | Intravenous infusion, sotrovimab, includes infusion and post administration monitoring | 5/26/21 | $360 |
| M0248 | Intravenous infusion, sotrovimab, includes infusion 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 | 5/26/21 | $600 |
The MA Program Fee Schedule has been updated with the fee increases and the new CPT codes previously noted to allow for payment of the administration of SARS-CoV-2 monoclonal antibody products to an MA beneficiary for treatment of SARS-CoV-2.
The Department issued an MA Bulletin to inform providers enrolled in the MA Program of the fee increase and the addition of the CPT codes previously noted for the administration of SARS-CoV-2 monoclonal antibody products to an MA beneficiary for treatment of SARS-CoV-2.
Fiscal Impact
There is no fiscal impact resulting from the addition of these procedure codes.
Public Comment
Interested persons are invited to submit written comments regarding this notice to the Department of Human Services, Office of Medical Assistance Programs, c/o Regulations Coordinator, Room 515, Health and Welfare Building, Harrisburg, PA 17120. Comments received within 30 days will be reviewed and considered for any subsequent revision to the MA Program Fee Schedule.
Persons with a disability who require an auxiliary aid or service may submit comments using the Pennsylvania Hamilton Relay Service at (800) 654-5984 (TDD users) or (800) 654-5988 (voice users).
MEG SNEAD,
Acting Secretary
Fiscal Note: 14-NOT-1501. No fiscal impact; (8) recommends adoption.
[Pa.B. Doc. No. 22-439. Filed for public inspection March 18, 2022, 9:00 a.m.]
No part of the information on this site may be reproduced for profit or sold for profit.
This material has been drawn directly from the official
Pennsylvania Bulletin full text database.
Due to the limitations of HTML or differences in display capabilities
of different browsers, this version may differ slightly from the
official printed version.
