Ask a Rev Cycle Expert: Appropriate Billing for Bamlanivimab?
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 Q0239, 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.
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