To prevent triggering a copay or deductible, CMS instructs institutional providers to bill monoclonal antibodies similar to vaccines.
A version of this article was first published April 5, 2021, by HCPro's Revenue Cycle Advisor, a sibling publication to HealthLeaders.
Q: What revenue codes are used to prevent triggering a copay or deductible when billing Medicare for COVID-19 monoclonal antibodies?
A: In the COVID-19 FAQs, Section BB, FAQ23, CMS added information on billing monoclonal antibody treatments. To prevent triggering a copay or deductible, CMS instructs institutional providers to bill monoclonal antibodies similar to vaccines as follows:
- Drugs are billed under revenue code 0636, the standard revenue code used for billing drugs with a HCPCS code assigned. Similar to vaccines, drugs received for free should either not be reported or be reported as non-covered with a token charge.
- Administration is billed under revenue code 0771, which is for Vaccine Administration under the Preventative Care Services category, even though this drug or combination of drugs is not technically a vaccine. Payment is set at $310.75, subject to wage adjustment.
- Condition code A6 (Vaccines/100% Medicare Payment).
- Diagnosis code Z23 (Encounter for Immunization).
Additionally, information on all the Medicare Administrative Contractor (MAC) websites instructs providers to reported U07.1 (COVID-19) as a secondary diagnosis code. Presumably, this demonstrates that the patient meets the requirements under the EUAs that the patient has been diagnosed with mild to moderate COVID-19.
For more information, see "Note from the instructor: CMS provides additional information on billing and coding for COVID-19 vaccines and monoclonal antibodies" by Kimberly Hoy, JD, CPC.
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