Add Q0221 for COVID-19 Preventive Drug

Check the dosage of Evusheld™ when comparing to existing code Q0220.

Medicare announced a new HCPCS Level II code for tixagevimab co-packaged with cilgavimab (EVUSHELD™), which providers administer as a preventive medicine for certain patients before exposure to COVID-19. The effective date of Q0221 is Feb. 24, 2022.

Compare Q0221 to Q0220

Note the 600 mg at the end of the descriptor for new code Q0221 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 whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg.

Dosage is the only difference between new code Q0221 and existing 300 mg code Q0220 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 whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg.

On Feb. 24, 2022, the Food and Drug Administration (FDA) revised the emergency use authorization (EUA) for Evusheld™ to change the initial dose. Originally, the recommended dosage was 150 mg of tixagevimab and 150 mg of cilgavimab, for a total of 300 mg. But due to decreased neutralization activity against certain COVID-19 subvariants, the initial dosage has changed to 300 mg of tixagevimab and 300 mg of cilgavimab, for a total of 600 mg.

Claims for Evusheld™

For both 300 mg code Q0220 and 600 mg code Q0221, the appropriate administration codes are:

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 whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring

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 whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 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

The agents in Evusheld™, tixagevimab and cilgavimab, are monoclonal antibodies. CMS states that when the government provides COVID-19 monoclonal antibody products for free, you should bill only for the administration. You should not include the monoclonal antibody product codes on those claims. “If you got the product for free, and your systems require a product code to bill for the administration, enter $0.01 for the billed amount,” CMS states.

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Deborah Marsh

Deborah Marsh, JD, MA, CPC, CHONC, is a senior development editor at AAPC. She has explored the ins and outs of coding for multiple specialties, particularly radiology, cardiology, and oncology.

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