COVID-19 Monoclonal Antibodies

The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.

Review information about Medicare payment for administering monoclonal antibodies during and after the PHE.

Review the Antiviral Resistance information in the fact sheet for each monoclonal antibody therapy authorized under an emergency use authorization (EUA) for details about specific variants and resistance. Also refer to the CDC and state and local health authorities for reports of viral variants of importance in your region to guide treatment decisions.

COVID-19 VEKLURY® (Remdesivir) in the Outpatient Setting

On April 25, 2022, the FDA approved a supplemental New Drug Application (NDA) for VEKLURY, which expanding its approval for use in the outpatient setting. View the FDA letter for more information about the NDA approval and revoked EUA.

The federal government isn’t purchasing VEKLURY. Medicare Part B pays for the drug and its administration under the applicable Medicare Part B payment policy when you provide it in the outpatient setting, according to the FDA approval. In most cases, your patient’s yearly Part B deductible and 20% coinsurance apply.

We created HCPCS code J0248 for VEKLURY, effective December 23, 2021. J0248 represents 1mg -- report units to reflect the dosage you administered for each patient.

For more information about billing and payment for VEKLURY in the outpatient setting:

COVID-19 Monoclonal Antibody Products

Monoclonal Antibodies for Pre-Exposure Prophylaxis of COVID-19

The FDA authorized the following investigational monoclonal antibody products under EUA for pre-exposure prophylaxis of COVID-19 in certain adults and adolescents:

  • EVUSHELDTM (tixagevimab co-packaged with cilgavimab) (EUA issued December 8, 2021, latest update January 26, 2023). On January 26, 2023, the FDA announced that EVUSHELD isn’t currently authorized for emergency use in the U.S.  
  • PEMGARDA (pemivibart) (EUA issued March 22, 2024, latest update August 26, 2024). For more information about the limits of authorized use -- including information about viral variants and antiviral resistance -- review the EUA fact sheet for health care providers for PEMGARDA.

 

Monoclonal Antibodies to Treat Mild-to-Moderate COVID-19

The FDA approved or authorized under EUA the following investigational monoclonal antibody therapies:

The FDA authorized these monoclonal antibody therapies to treat mild-to-moderate COVID-19 in adults and pediatric patients who:

  • Have a positive COVID-19 test result
  • Are at high risk for progressing to severe COVID-19, hospitalization, or both

You may administer these monoclonal antibody therapies only in settings where they have both:

  • Immediate access to medications to treat a severe infusion reaction, such as anaphylaxis
  • The ability to activate the emergency medical system (EMS)

Viral Variants & Monoclonal Antibody Resistance

The virus that causes COVID-19 (SARS-CoV-2) is constantly changing, and CDC expects new viral variants to continue to emerge. For details about specific variants and monoclonal antibody resistance, review the antiviral resistance information in each of the Fact Sheets listed above.

Learn about viral variants in your area to help you make treatment decisions:

  • Review the CDC information on Variant Proportions
  • Refer to information from your state and local health authorities

Medicare & COVID-19 Monoclonal Antibody Products

You can purchase currently authorized monoclonal antibody products through typical purchasing channels.


Coverage

Medicare Coverage for COVID-19 Monoclonal Antibody Products

Medicare covers and pays for monoclonal antibody infusions and injections used for post-exposure prophylaxis or COVID-19 treatment under the Part B preventive vaccine benefit. This coverage applies when the product is furnished consistent with its approval or EUAs. Coverage continues through the end of the calendar year in which the EUA declaration for COVID-19 drugs and biologicals ends. 

The EUA declaration is separate from the PHE for COVID-19. Learn  what happens to EUAs when a PHE ends.

Note:

Medicare will only cover and pay for:

  •  Bamlanivimab (administered alone) if it was furnished, consistent with the terms of the EUA, between November 10, 2020 – April 16, 2021
  • Bamlanivimab and etesevimab (administered together) if furnished, consistent with the terms of the EUA, between February 9, 2021 – December 14, 2023


Paying for these products under the Part B preventive vaccine benefit--through the end of the calendar year in which the EUA declaration for COVID-19 drugs and biologicals ends-- allows a broad range of providers to administer them, including :

  • Freestanding and hospital-based infusion centers
  • Home health agencies
  • Nursing homes
  • Entities that nursing homes contract with to administer products
Note:
To help skilled nursing facilities (SNFs) efficiently administer COVID-19 vaccines--including COVID-19 monoclonal antibody products-- to residents, CMS exercised enforcement discretion. This allowed Medicare-enrolled immunizers to bill Medicare directly and get reimbursement for administering vaccines to Medicare SNF residents. This enforcement discretion ended on June 30, 2023.

Starting January 1 of the year after the EUA declaration ends:

  • We’ll will pay you for monoclonal antibody products used for post-exposure prophylaxis or COVID-19 treatment  the same way we pay for biological products under Section 1847A of the Social Security Act. That is, through the applicable payment system and using the appropriate coding and payment rates, like the way we pay for administering other complex biological products.
  • We’ll continue to pay for covered monoclonal antibody products and their administration when used for pre-exposure prophylaxis under the Part B preventive vaccine benefit.
Coding

Coding for the Administration of COVID-19 Monoclonal Antibody Products

Get codes for COVID-19 monoclonal antibody products and administration for Medicare payment:

Product


EUA Effective & Revocation Date(s)

Product Code

Administration Code

Eli Lilly and Company’s Antibody Bamlanivimab (LY-CoV555)

November 10, 2020 - April 16, 2021

Note: On April 16, 2021, the FDA revoked the EUA for bamlanivimab when administered alone

Q0239

Long descriptor: Injection, bamlanivimab-xxxx, 700 mg

Short descriptor: Bamlanivimab-xxxx

 

M0239

Long descriptor: Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring

Short descriptor: Bamlanivimab-xxxx infusion

Regeneron’s Antibody REGEN-COV (casirivimab and imdevimab) (ZIP)

Note: This product isn’t currently authorized[1]

November 21, 2020 - December 13, 2024

Note: While the product EUA was originally issued on November 21, 2020, these product and administration codes are effective July 30, 2021

Q0240[2]

Long descriptor: Injection, casirivimab and imdevimab, 600 mg

Short descriptor: Casirivi and imdevi 600 mg

M0240[2]

Long descriptor: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses

Short descriptor: Casirivi and imdevi repeat

Regeneron’s Antibody REGEN-COV (casirivimab and imdevimab) (ZIP)
 

Note: This product isn’t currently authorized[1]

November 21, 2020 - December 13, 2024

Note: While the product EUA was originally issued on November 21, 2020, these product and administration codes are effective July 30, 2021

Q0240[2]

Long descriptor: Injection, casirivimab and imdevimab, 600 mg

Short descriptor: Casirivi and imdevi 600 mg

M0241[2]

Long descriptor: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or 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, subsequent repeat doses

Short descriptor: Casirivi and imdevi repeat hm

Regeneron’s Antibody REGEN-COV (casirivimab and imdevimab) (ZIP)

Note: This product isn’t currently authorized[1]

November 21, 2020 - December 13, 2024

 

Q0243

Long descriptor: Injection, casirivimab and imdevimab, 2400 mg

Short descriptor: Casirivimab and imdevimab

Q0244[3]

Long descriptor: Injection, casirivimab and imdevimab, 1200 mg

Short descriptor: Casirivi and imdevi 1200 mg

M0243

Long descriptor: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring

Short descriptor: Casirivi and imdevi inj

Regeneron’s Antibody REGEN-COV (casirivimab and imdevimab) (ZIP)

Note: This product isn’t currently authorized[1]

November 21, 2020 – December 13, 2024
Note: While the product EUA was issued on November 21, 2020, this administration code is effective May 6, 2021   

Q0243

Long descriptor: Injection, casirivimab and imdevimab, 2400 mg

Short descriptor: Casirivimab and imdevimab

Q0244[3]

Long descriptor: Injection, casirivimab and imdevimab, 1200 mg

Short descriptor: Casirivi and imdevi 1200 mg

M0244

Long descriptor: Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or 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

Short descriptor: Casirivi and imdevi inj hm

Eli Lilly and Company’s Antibody Bamlanivimab and Etesevimab (ZIP)
 

February 9, 2021 – December 14, 2023

Note: On December 14, 2023, the FDA revoked the EUA for bamlanivimab and etesevimab, administered together

Q0245[4]

Long descriptor: Injection, bamlanivimab and etesevimab, 2100 mg

Short descriptor: Bamlanivimab and etesevima

M0245[4]

Long descriptor: Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring

Short descriptor: Bamlan and etesev infusion

Eli Lilly and Company’s Antibody Bamlanivimab and Etesevimab, (ZIP) 
 

February 9, 2021  – December 14, 2023

Note: While the product EUA was issued on February 9, 2021, this administration code is effective May 6, 2021  

Note: On December 14, 2023, the FDA revoked the EUA for bamlanivimab and etesevimab, administered together

Q0245[4]

Long descriptor: Injection, bamlanivimab and etesevimab, 2100 mg

Short descriptor: Bamlanivimab and etesevima

M0246[4]

Long descriptor: Intravenous infusion, bamlanivimab and etesevimab, includes infusion 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

Short descriptor:
Bamlan and etesev infus home

GlaxoSmithKline’s Antibody Sotrovimab

Note: This product isn’t currently authorized[6]

May 26, 2021 - December 13, 2024

Q0247

Long descriptor: Injection, sotrovimab, 500 mg

Short descriptor: Sotrovimab

M0247

Long descriptor: Intravenous infusion, sotrovimab, includes infusion and post administration monitoring

Short descriptor: Sotrovimab infusion

GlaxoSmithKline’s Antibody Sotrovimab

Note: This product isn’t currently authorized[6]

May 26, 2021 - December 13, 2024

Q0247

Long descriptor: Injection, sotrovimab, 500 mg

Short descriptor: Sotrovimab

M0248

Long descriptor: Intravenous infusion, sotrovimab, includes infusion 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

Short descriptor: Sotrovimab inf, home admin

Genentech’s Antibody ACTEMRA (tocilizumab)June 24, 2021 – August 8, 2025

Q0249[5]

Long descriptor: 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

Short descriptor: Tocilizumab for COVID-19

M0250

Long descriptor: Intravenous infusion, 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, includes infusion and post administration monitoring, second dose

Short descriptor: Adm Tocilizu COVID-19 2nd

AstraZeneca’s Antibody EVUSHELD (tixagevimab and Cilgavimab) Note: This product isn’t currently authorized[8]December 8, 2021 – December 13, 2024

Q0220

Long descriptor: 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

Short descriptor: Tixagev and cilgav inj

M0220

Long descriptor: 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

Short descriptor: Tixagev and cilgav inj

AstraZeneca’s Antibody EVUSHELD (tixagevimab and Cilgavimab) Note: This product isn’t currently authorized[8]December 8, 2021 – December 13, 2024

Q0220

Long descriptor: 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

Short descriptor: Tixagev and cilgav inj

M0221

Long descriptor: 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

Short descriptor: Tixagev and cilgav inj hm

AstraZeneca’s Antibody EVUSHELD (tixagevimab and Cilgavimab) Note: This product isn’t currently authorized[8]February 24, 2022 - December 13, 2024

Q0221

Long descriptor: 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

Short descriptor: Tixagev and cilgav, 600mg

M0220

Long descriptor: 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

Short descriptor: Tixagev and cilgav inj

AstraZeneca’s Antibody EVUSHELD (tixagevimab and Cilgavimab) Note: This product isn’t currently authorized[8]February 24, 2022 - December 13, 2024

Q0221

Long descriptor: 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

Short descriptor: Tixagev and cilgav, 600mg

M0221

Long descriptor: 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

Short descriptor: Tixagev and cilgav inj hm

Eli Lilly and Company’s Antibody Bebtelovimab (PDF)

Note: This product isn’t currently authorized[7]

February 11, 2022 - December 13, 2024

Q0222

Long descriptor: Injection, bebtelovimab, 175 mg

Short descriptor: Bebtelovimab 175 mg 

M0222

Long descriptor: Intravenous injection, bebtelovimab, includes injection and post administration monitoring

Short descriptor: Bebtelovimab injection

Eli Lilly and Company’s Antibody Bebtelovimab (PDF)

Note: This product isn’t currently authorized[7]

February 11, 2022 - December 13, 2024

Q0222

Long descriptor: Injection, bebtelovimab, 175 mg

Short descriptor: Bebtelovimab 175 mg 

M0223

Long descriptor: Intravenous injection, bebtelovimab, 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
 

Short descriptor: Bebtelovimab injection home

 [1] On January 24, 2022, the FDA announced that, due to the high frequency of the Omicron variant, REGEN-COV (casirivimab and imdevimab, administered together) isn’t currently authorized in any U.S region. Don't administer REGEN-COV for treatment or post-exposure prevention of COVID-19 under the EUA until further notice.

[2] On July 30, 2021, the FDA revised the EUA for REGEN-COV (casirivimab and imdevimab, administered together) to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. For patients who meet the criteria for repeat dosing, the authorized dosage is an initial dose of 1200 mg, followed by subsequent repeat dosing of 600 mg once every 4 weeks for the duration of ongoing exposure. As a result, CMS issued a new product code for REGEN-COV of 600 mg (Q0240) and 2 new codes for the administration of repeat doses of REGEN-COV (M0240/M0241). Providers and suppliers who administer REGEN-COV for PEP should use M0243 or M0244 for administering the first dose and M0240 or M0241 for administering subsequent repeat doses.

[3] On June 3, 2021, the FDA revised the EUA for REGEN-COV (casirivimab and imdevimab, administered together) to change the allowed dosing regimen from 2400 mg to 1200 mg and allow providers to administer the combination product by subcutaneous injection in limited circumstances. As a result, CMS issued a new product code for REGEN-COV (Q0244) and updated the descriptors for the existing administration codes (M0243/M0244).

[4] On September 16, 2021, the FDA revised the EUA for bamlanivimab and etesevimab, administered together, to allow its use for post-exposure prophylaxis (PEP) in certain adult and pediatric patients. Providers and suppliers should use Q0245 and M0245 or M0246 to bill for administering bamlanivimab and etesevimab for PEP.

[5] Given the limited clinical situations allowed under the FDA approval and EUA, you should only bill for ACTEMRA (tocilizumab) on a 12x type of bill (TOB).

[6] On April 5, 2022, the FDA announced that, due to the high frequency of the Omicron BA.2 sub-variant, sotrovimab isn’t currently authorized in any U.S. region. Therefore, you may not administer sotrovimab to treat COVID-19 under the EUA until further notice.

[7] On November 30, 2022, the FDA announced that bebtelovimab isn’t currently authorized in any U.S. region because it isn’t expected to neutralize Omicron sub-variants BQ.1 and BQ.1.1. Therefore, you may not administer bebtelovimab to treat COVID-19 under the EUA until further notice.

[8] On January 26, 2023, the FDA announced that EVUSHELD isn’t currently authorized for emergency use in the U.S. 

Get the most current list of billing codes, payment allowances, and effective dates.

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 under Section 3713 of the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). 

We’ll continue to pay for COVID-19 monoclonal antibodies for post-exposure prophylaxis or  COVID-19 treatment under the Part B preventive vaccine benefit. This coverage continues through the end of the calendar year in which the EUA declaration for COVID-19 drugs and biologicals ends. 

The EUA declaration is separate from the PHE for COVID-19. Learn what happens to EUAs when a PHE ends. 

During this interim period, we’ll maintain the administration payment amounts when you infuse or inject these products in:

  • Health care settings 
  • The home

Effective January 1 of the year after the EUA declaration ends:

  • We’ll pay you for monoclonal antibody products used for post-exposure prophylaxis or COVID-19 treatment the same way we pay for biological products under Section 1847A of the Social Security Act-- through the applicable payment system, using the proper coding and payment rates, similar to how we pay for administering other complex biological products.
  • We’ll continue to pay for covered monoclonal antibody products and their administration when used as pre-exposure prophylaxis for prevention of COVID-19 under the Part B preventive vaccine benefit.

Payment Rates for Infusion

Effective for services furnished on or after May 6, 2021, the Medicare payment rate for administering FDA-authorized or -approved COVID-19 monoclonal antibody products through infusion is approximately $450.

  • This rate applies to all providers not paid reasonable cost for furnishing these products 
  • The rate reflects updated information about the costs of administering monoclonal antibody products for different provider types and the resources needed to make sure providers safe and proper administration
  • We geographically adjust the rate based on where you furnish the service
Note:

Under the FDA approval and EUA, health care providers can administer ACTEMRA (tocilizumab) only to hospitalized patients in limited clinical situations. The Medicare payment rate of approximately $450 applies for administering ACTEMRA when you furnish it under the FDA approval or EUA—the same rate that applies to other COVID-19 monoclonal antibody products.

The FDA approval and EUA also allows for 2 infusions for the same patient in limited situations. When 2 infusions are clinically necessary, Medicare will pay approximately $450 per infusion. 

This separate Medicare payment of $450 per infusion applies to all hospitals who aren’t paid reasonable cost for furnishing these products consistent with the FDA approval or EUA. We geographically adjust the rate based on where you furnish the service. Get the most current geographically adjusted rates. 

 

Note:

The July 30, 2021, revised EUA for REGEN-COV (casirivimab and imdevimab, administered together) allows its use for post-exposure prophylaxis (PEP) for certain patients who’ve been exposed to --or are at high risk of exposure to -- a person with COVID-19. 

When billing for REGEN-COV in these situations, use the following HCPCS codes:

DoseHealth Care SettingHome
Initial doseM0243M0244
Subsequent repeat dose(s)M0240M0241

The September 16, 2021, revised EUA for bamlanivimab and etesevimab allowed its use for PEP in certain adult and pediatric patients. 

The FDA revoked the EUA for bamlanivimab and etesevimab on December 14, 2023. 

For dates of services before December 14, 2023, use the following HCPCS codes to bill for administering bamlanivimab and etesevimab for both PEP and treatment: 

SettingHCPCS Code
Health care settingM0245
Home or residenceM0246


Payment Rates for Intravenous Injections

Effective February 11, 2022, CMS updated the Medicare payment rates for the administering COVID-19 monoclonal antibody products by intravenous (IV) injection. 

For IV injection services furnished on or after February 11, 2022 -- such as the administration of bebtelovimab -- the Medicare payment rate for administering FDA-authorized or -approved COVID-19 monoclonal antibody products is approximately $350.50.

  • This rate applies to all providers not paid reasonable cost for furnishing these products 
  • The rate reflects updated information about the costs of administering these monoclonal antibody products for different provider types and the resources needed to ensure safe and proper administration 
  • We geographically adjust the rate based on where you furnish the service

Get the most current list of billing codes, payment allowances, and effective dates for currently authorized monoclonal antibody products.

More Information about Payment for Infusion & IV Injection

Medicare also pays for treatment to address major complications:

  • As needed and appropriate
  • Consistent with existing payment methods for the care setting where you provide the treatment

For COVID-19 monoclonal antibody products administered before May 6, 2021, the Medicare payment rate is approximately $310.

Medicare will establish codes and rates for administering new products as the FDA approves or authorizes each product.

Get the most current list of billing codes, payment allowances, and effective dates for currently authorized monoclonal antibody products.

Payment Rates for Infusion at Home

Beginning on May 6, 2021, Medicare established separate coding and payment for administering COVID-19 monoclonal antibody products through infusion in a patient’s home or residence. 

Effective for services furnished on or after May 6, 2021, the Medicare payment rate for administering these products through infusion in a patient’s home or residence is about $750.

  • This rate reflects updated information about the costs of furnishing these complex products in a patient’s home 
  • For many providers, we also geographically adjust this rate based on where you furnish the service 

Payment Rates for IV Injection at Home

Effective February 11, 2022, Medicare established separate coding and payment for administering COVID-19 monoclonal antibody products through IV injection in a patient’s home or residence. 

For services furnished on or after February 11, 2022, the Medicare payment rate for administering COVID-19 monoclonal antibody products through IV injection -- such as bebtelovimab -- in a patient’s home or residence is approximately $550.50.

  • The rate reflects updated information about the costs of furnishing these complex products in a patient’s home 
  • For many providers, we also geographically adjust this rate based on where you furnish the service 

More Information about Payment for Infusion & IV Injection at Home

Note:

These rates don’t apply if Medicare pays you for preventive vaccines and their administration at reasonable cost -- for example: 

  • Federally Qualified Health Centers (FQHCs)
  • Rural Health Clinics (RHCs)
  • Hospital-based Renal Dialysis Facilities  
     

Effective July 1, 2025, FQHCs and RHCs must report all Part B preventive vaccines and their administration – pneumococcal, influenza, hepatitis B, and COVID-19 -- on the claim for payment at the time of service.

Providers may bill for the higher home payment rate when they furnish a COVID-19 monoclonal antibody product in a “home or residence.” This includes: 

  • A Medicare patient’s permanent residence 
  • Temporary lodging such as a hotel or motel, hostel, or homeless shelter
Note:
During the COVID-19 PHE, providers could bill for the higher home payment rate for monoclonal antibody products they furnished in a home or residence that was made provider-based to the hospital. This policy ended on May 11, 2023. 

If your Medicare patient permanently lives in a setting that provides health care services — such as an intermediate care facility, nursing facility, or SNF — that setting counts as their "home or residence." You can bill HCPCS codes M0241, M0244, M0246, M0248, or M0223 for services provided there.

However, if the patient is only staying there temporarily — for example, they have a permanent home but are completing a post-acute stay in a SNF — that setting doesn’t count as their "home or residence." In that case, don’t bill the higher "at home" codes.

Note:

Under the terms of their respective EUAs:

  • Providers may infuse ACTEMRA (tocilizumab) only in the hospital setting, in limited clinical situations
  • Providers should administer PEMGARDA (pemivibart) only where health care providers have immediate access to medications to treat a severe hypersensitivity reaction -- such as anaphylaxis -- and the ability to activate the emergency medical system (EMS) if necessary

Providers may not furnish ACTEMRA or PEMGARDA in the “home or residence." As a result, Medicare hasn’t created a separate HCPCS code for billing the higher Medicare payment amount for administering ACTEMRA or PEMGARDA in the home. 


If you administer COVID-19 monoclonal antibodies to Medicare patients in traditional health care locations –such as a hospital outpatient infusion clinic or freestanding infusion clinic -- continue to bill the applicable HCPCS code:

  • M0240
  • M0243 
  • M0245
  • M0247
  • M0222
  • M0224

Inpatient locations never qualify as a patient’s “home or residence” for purposes of the higher “at home” HCPCS codes. This includes:

  • Inpatient hospitals
  • Inpatient psychiatric hospitals
  • Long-term care hospitals
  • Inpatient rehabilitation hospitals

Don’t bill HCPCS codes M0241, M0244, M0246, M0248, or M0223 for services furnished in these inpatient settings. 

Get the most current list of billing codes, payment allowances, and effective dates for currently authorized monoclonal antibody products.

Payment Rates for Intramuscular Injection

Effective for services furnished on or after December 8, 2021, the Medicare payment rate for administering COVID-19 monoclonal antibody products through intramuscular injection for pre-exposure prophylaxis -- such as EVUSHELD -- in select patient populations, is about $150.50.

  • This rate applies to all providers not paid reasonable cost for furnishing these products 
  • The rate reflects information about the costs of administering monoclonal antibody products for different provider types and the resources needed to make sure safe and proper administration
  • We geographically adjust the rate based on where you furnish the service

Payment Rates for Intramuscular Injection at Home

Effective for services furnished on or after December 8, 2021, the Medicare payment rate for administering COVID-19 monoclonal antibody products through intramuscular injection for pre-exposure prophylaxis -- such as EVUSHELD -- in select patient populations, in a patient’s home or residence, is approximately $250.50.

  • The rate reflects information about the costs of furnishing these complex products in a patient’s home 
  • For many providers, we also geographically adjust this rate based on where you furnish the service
Note:

These rates don’t apply if Medicare pays you for preventive vaccines and their administration at reasonable cost -- for example:

  • FQHCs
  • RHCs
  • Hospital-based renal dialysis facilities
     

Effective July 1, 2025, FQHCs and RHCs must report all Part B preventive vaccines and their administration – pneumococcal, influenza, hepatitis B, and COVID-19 -- on the claim for payment at the time of service.


Providers may bill the higher home payment rate when they furnish a COVID-19 monoclonal antibody product in a “home or residence.” This includes:

  • Medicare patient’s permanent residence
  • Temporary lodging, such as a hotel or motel, hostel, or homeless shelter

If your Medicare patient permanently lives in a setting that provides health care services — such as an intermediate care facility, nursing facility, or SNF — that setting counts as their "home or residence." You can bill HCPCS code M0221 for services provided there.

However, if the patient is only staying there temporarily — for example, they have a permanent home but are completing a post-acute stay in a SNF — that setting doesn’t count as their "home or residence." In that case, don’t bill the higher "at home" code. 

If you administer these COVID-19 monoclonal antibody products to Medicare patients in traditional health care locations such as a hospital outpatient infusion clinic or freestanding infusion clinic -- continue to bill HCPCS code M0220, as applicable. 

Inpatient locations never qualify as a patient’s “home or residence” for purposes of HCPCS code M0221. This includes:

  • inpatient hospitals
  • Inpatient psychiatric hospitals
  • Long-term care hospitals
  • Inpatient rehabilitation hospitals 

Payment for Product

In response to the COVID-19 PHE, the government initially purchased COVID-19 monoclonal antibody products and made them available at no cost. We don’t pay for the COVID-19 monoclonal antibody products that providers get at no cost, including:

  • Bebtelovimab (if you got the product at no cost)
  • EVUSHELD (tixagevimab co-packaged with cilgavimab, administered as 2 separate consecutive intramuscular injections)
  • REGEN-COV (casirivimab and imdevimab, administered together)
  • Sotrovimab

The government won’t purchase the following products and make them available at no cost:

  • ACTEMRA (tocilizumab)
  • Bebtelovimab (starting August 15, 2022)
  • PEMGARDA (pemivibart) 
Note:
We pay for ACTEMRA (tocilizumab) based on the number of units administered, so include the total number of units administered on the claim per day. For example, if you administer 200mg of ACTEMRA in 1 infusion, add 200 as the number of units on the claim. If you give 2 infusions in the same day, include the total units for both infusions with product code Q0249 on 1 line (per day).

 

Note:

Starting August 15, 2022, bebtelovimab will be commercially available. You may have both U.S. Government (USG)-purchased and commercial product in your inventory. 

  • For dates of service on or after August 15, 2022, only bill Medicare for the product if you use commercially purchased products. Don’t bill for USG-purchased products. 
  • Continue to bill for administering either type of product.
  • Check the Batch # on the vial. If the Batch # is D534422, the product was commercially purchased. Watch for Eli Lilly to release more information about future batch numbers.

We set the payment rate for COVID-19 monoclonal antibody products the same way we set the payment rate for COVID-19 vaccines. For example, we pay 95% of AWP for COVID-19 vaccines provided in the physician office setting, and we pay hospital outpatient departments at reasonable cost for COVID-19 vaccines. 

Get the most current payment allowances and effective dates for these products.

Billing

Billing for Administering COVID-19 Monoclonal Antibody Products

You can bill on a single claim for administering COVID-19 monoclonal antibody products, or submit claims on a roster bill.   

  • The FDA approvals and EUAs for COVID-19 monoclonal antibody products contain specific requirements for administration that are considerably more complex than for other services that use roster billing. We expect you to maintain proper medical documentation that supports the medical necessity of the service, including:
    • Documentation that supports that the provider met the terms of the approvals or EUAs
    • Documenting the name of the provider who ordered or administered the infusion or injection, even in cases where providers use roster billing to submit claims for these services
  • If the government supplies the COVID-19 monoclonal antibody products at no cost,  only bill for the administration.
    • Don’t include the monoclonal antibody product codes on these claims
    • If you get the product at no cost and your systems require a product code to bill for the administration, enter $0.01 for the billed amount
  • Medicare covers and pays for COVID-19 monoclonal antibodies under the Part B preventive vaccine benefit until the end of the year in which the HHS Secretary ends the EUA declaration for COVID-19 drugs and biologics.
  • If you’re enrolled as a mass immunizer, you may be able to bill Medicare for administering monoclonal antibodies, consistent with the product’s FDA approval or EUA and under the state law and scope of practice. 
  • Mass immunizers may bill using a roster bill or a traditional claim form, such as a CMS-1500 (PDF) or the 837P electronic format. CMS systems will accept roster bills for 1 or more patients that get the same type of shot (or in the case of monoclonal antibodies, same type of infusion or injection) on the same date of service. 

  • For Medicare Advantage (MA) plan patients (except for most MA hospice patients), submit claims for administering COVID-19 monoclonal antibody products to the MA plan. Original Medicare won’t pay these claims. 

    For most MA hospice patients, submit claims to Original Medicare. If your hospice patient’s MA plan participates in the Hospice Benefit Component of the Value-Based Insurance Design Model, submit claims for administering COVID-19 monoclonal antibody products to the MA plan. Original Medicare won’t pay these claims.

  • Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs)
    • For Original Medicare patients, Medicare pays RHCs and FQHCs for administering COVID-19 monoclonal antibody products at 100% of reasonable cost through the cost report. 

      Effective July 1, 2025, FQHCs and RHCs must report all Part B preventive vaccines and their administration – pneumococcal, influenza, hepatitis B, and COVID-19 -- on the claim for payment at the time of service.
    • For MA patients, RHCs and FQHCs should submit claims for administering COVID-19 monoclonal antibody products to the MA plan. Original Medicare won’t pay these claims. Visit the FQHC Center or review our FAQs (PDF) for  billing and payment, including MA wrap-around payments. 

There’s No Cost for Your Patients

People with Medicare pay no cost sharing for COVID-19 monoclonal antibody products or their administration. This means your patients don't pay a copay, coinsurance or deductible:

  • Through the end of the calendar year in which the EUA declaration ends, for monoclonal antibody products used for post-exposure prophylaxis or  COVID-19
  • Permanently for covered monoclonal antibody products used as pre-exposure prophylaxis or COVID-19 treatment

 

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Page Last Modified:
03/13/2026 10:18 AM
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