COVID-19 VEKLURYTM (remdesivir)
Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel about therapies for the COVID-19 Omicron variant, CMS created HCPCS code J0248 for VEKLURY™ (remdesivir) antiviral medication when administered in an outpatient setting.
COVID-19 Monoclonal Antibody Products
The FDA authorized the following investigational monoclonal antibody product under EUA for pre-exposure prophylaxis of COVID-19:
Important Update about Viral Variants
On April 16, 2021, the FDA revoked the EUA for bamlanivimab, when administered alone , due to a sustained increase in COVID-19 viral variants in the U.S. that are resistant to the solo product.
Medicare Coverage for COVID-19 Monoclonal Antibody Products
During the COVID-19 public health emergency (PHE), Medicare will cover and pay for these infusions (when furnished consistent with their respective EUAs) the same way it covers and pays for COVID-19 vaccines.
Coding for the Administration of COVID-19 Monoclonal Antibody Products
CMS identified specific code (s) for each COVID-19 monoclonal antibody product and specific administration code (s) for Medicare payment:
Medicare Payment for Administering COVID-19 Monoclonal Antibody Products
To ensure immediate access during the COVID-19 PHE, Medicare covers and pays for these infusions and injections in accordance with Section 3713 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) .
Billing for Administering COVID-19 Monoclonal Antibody Products
Health care providers can bill on a single claim for administering COVID-19 monoclonal antibody products, or submit claims on a roster bill.
WHAT IS A MONOCLONAL ANTIBODY?
Your body naturally makes antibodies to fight infection. However, your body may not have antibodies designed to recognize a novel (or new) virus like SARS-CoV-2, the virus that causes COVID-19.
How Can I Get Monoclonal Antibodies?
To receive a mAb you should be referred for treatment by your healthcare professional and directed to available infusion locations. If you do not have a healthcare provider, call the Combat COVID Monoclonal Antibodies Call Center at 1-877-332-6585 to find out who to talk with about your symptoms and treatment.
WHAT IF I DO NOT QUALIFY FOR MONOCLONAL ANTIBODY TREATMENT?
Your healthcare professional may decide you do not qualify for mAb treatment. There could be several reasons for this. You may not meet all eligibility criteria or you may have an underlying health condition that disqualifies you for mAb treatment.
WHAT CAN I EXPECT FROM TREATMENT (INFUSION)?
The mAb treatment is usually offered at an infusion center because the treatment is given through an intravenous (IV) infusion or shots. Depending on the mAb treatment you receive, the whole process takes about 1-3 hours, depending on the treatment..
CAN MONOCLONAL ANTIBODY TREATMENT MAKE ME SICK?
Antibody treatments do not contain any live SARS-CoV-2, so there is no risk you will get COVID-19 from mAb treatment. However, the antibody treatment may have side effects:
What is the purpose of monoclonal antibody therapy?
The goal of this therapy is to help prevent hospitalizations, reduce viral loads and lessen symptom severity.
What are monoclonal antibodies?
However, monoclonal antibodies are mass-produced in a laboratory and are designed to recognize a specific component of this virus — the spike protein on its outer shell .
What antibodies interfere with the virus?
By targeting the spike protein, these specific antibodies interfere with the virus' ability to attach and gain entry into human cells. The two monoclonal antibody therapies currently available are the bamlanivimab and a combination of the casirivimab and imdevimab.
How long should you wait to get a second shot?
If you already received the first dose of vaccine before monoclonal antibody therapy, current CDC guidelines recommend you wait 90 days before receiving the second dose. Categories: Tips to Live By. Tags: Coronavirus, Infectious Disease.
What are the high risk people?
Those who are at high risk include people who: Are 65 years of age or older. Are at least 55 years of age and have heart disease, hypertension or a chronic respiratory disease such as COPD. Have a BMI above 35. Have chronic kidney disease.
