HCPCS Range COVID-19 Infusion Therapy

• 1 Injection, casirivimab and imdevimab, 2400 mg ( Q0243 )

• 2 Injection, bamlanivimab and etesevimab, 2100 mg ( Q0245 )

• 3 Injection, sotrovimab, 500 mg ( Q0247 )

• 4 Injection, casirivimab and imdevimab, 1200 mg ( Q0244 )

• 5 Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg ( Q0249 )

• 6 Injection, casirivimab and imdevimab, 600 mg ( Q0240 )

• 7 Injection, bebtelovimab, 175 mg ( Q0222 )

• 8 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 ( Q0220 )

• 9 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 ( Q0221 )