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Take 5 – Medical Coding News – August 2021

Take 5 – Medical Coding News – August 2021

What are the latest code changes? Get the facts, fast.

This month, there’s new billing guidance for a COVID-19 vaccine; there are three new HCPCS Level II codes for COVID-19 therapeutic injections; and Medicare payment allowances for the 2021-22 influenza vaccine codes have been released.

FDA Approves COVID-19 Vaccine

Pfizer’s COVID-19 vaccine received the green light on Aug. 23 from the U.S. Food and Drug Administration (FDA). This is the first COVID-19 vaccine to receive full FDA approval. Previously it shared emergency use authorization (EUA) with two other COVID-19 vaccines: Moderna and Janssen (Johnson & Johnson).

The Pfizer-BioNTech COVID-19 vaccine will now be marketed as Comirnaty, according to an FDA press release. The FDA-approved two-dose vaccine is available for the prevention of COVID-19 in individuals 16 years and older.

The vaccine remains available under EUA for individuals 12 through 15 years of age and, more recently, for third doses to certain immunocompromised patients.

New Codes for COVID-19 Monoclonal Antibodies

On July 30, 2021, the FDA revised the EUA for casirivimab and imdevimab to allow the drug combo to be used for post-exposure prophylaxis (PEP) in adult and pediatric patients who have been exposed, or who are at high risk for being exposed, to the SARS virus that causes COVID-19.

Report the initial dose of 1,200 mg with two units of new code:

Q0240 Injection, casirivimad and imdevimad, 600 mg

Also report the appropriate HCPCS Level II administration code for the initial dose:

M0243 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring

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

Report subsequent repeat dosing of 600 mg once every four weeks for the duration of ongoing exposure with one unit of Q0230 and the appropriate new HCPCS Level II administration code:

M0240 Intravenous infusion or subcutaneous injection, casirivimab and imdevimab incudes 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

Payment allowances and effective dates for COVID-19 monoclonal antibodies and their administration during the PHE are available on CMS’ website.

2021-22 Seasonal Flu Vaccine Pricing

The Centers for Medicare & Medicaid Services has posted payment allowances for influenza (flu) vaccines for the 2021-2022 season. The new season starts August 1 and ends July 31 the following year.

Thus far, there’s one less code this season, CPT® 90653, and payment rates have all increased a small margin.

The payment rate for Medicare HCPCS Level II administration code G0008 Administration of influenza virus vaccine remains in effect through the end of the calendar year.

The Centers for Disease Control and Prevention issued on Aug. 27 flu vaccine recommendations for the upcoming season.

Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

2 Responses to “Take 5 – Medical Coding News – August 2021”

  1. Melanie says:

    Isnts it Q0244? I don’t see Q0240 as a valid code

  2. Renee Dustman says:

    No, Q0240 is correct. It’s new, effective 7/30. Click on the Payment Allowances link to go to the CMS website, where the codes are listed.

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