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Ask a Rev Cycle Expert: Appropriate Billing for Bamlanivimab?

Articles

Question:

Can you clarify appropriate billing for the use of bamlanivimab? Is there a 'minimal' charge that is required when the drug is provided to the facility at no cost?

Answer:

The government has contracted with Eli Lilly to purchase almost 1 million doses of bamlanivimab that will be distributed to a broad range of providers and suppliers in accordance with the emergency use authorization (EUA) that became effective on November 9, 2020. Distribution of this drug will be at the discretion of the Centers for Medicare & Medicaid Services (CMS) for treatment of patients with mild-to-moderate COVID-19 infections who are at high risk for progressing to severe COVID-19 and/or hospitalization.

When treating a patient with bamlanivimab, facilities should report the code for the drug using HCPCS code Q2039, Injection, bamlanivimab, 700 mg, and for the administration of the drug using HCPCS code M0239 Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring. The national payment rate for the infusion will be $309.60. The drug, which is currently being provided at no cost, will not receive separate reimbursement. However, the drug must also be billed on the claim with a token charge of less than $1.01 in order to pass existing claims processing edits.

Disclaimer: This information was current at the time of its publishing and is designed to provide accurate information in regard to the subject matter covered. Vitalware does not accept any responsibility or liability with regard to any errors, omissions, misuses, or misinterpretation by the reader. It is not intended to take the place of either the written policies or regulations. We encourage you to review the specific regulations and other interpretive materials as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).