Bebtelovimab Administration added as New COVID-19 Monoclonal Antibody Benefit
March 8, 2022
Effective for dates of service on or after February 1, 2022, the U.S. Food and Drug Administration (FDA) granted an Emergency Use Authorization (EUA) to a new monoclonal antibody product, bebtelovimab (intravenous injections), for treatment of mild-to-moderate COVID-19 in adults and pediatric patients (12 years of age and older weighing at least 40 kg) who are at high risk for progression to severe COVID-19, including hospitalization or death and for whom alternative COVID-19 treatment options approved or authorized by the FDA are not accessible or clinically appropriate.
The Department of Health Care Services (DHCS) has established the following HCPCS codes associated with this new policy as benefits or non-benefits as applicable.
Intravenous injection, bebtelovimab, includes injection and post administration monitoring
||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
||Injection, bebtelovimab, 175 mg
DHCS allows a broad range of providers and suppliers to administer these treatments, including but not limited to:
- Freestanding and hospital-based infusion centers
- Home health agencies
- Nursing homes
- Entities with which nursing homes contract to administer treatment
Specific billing policy when billing Medi-Cal for HCPCS codes M0222 or M0223, will be released in the next Medi-Cal Update. Providers are advised to hold the submission of claims for these benefits until June 1, 2022, when the Medi-Cal system can be properly updated.
For a list of all billable COVID-19 monoclonal antibody services, see the “Reimbursement of COVID-19 Vaccine and Monoclonal Antibody Administration for Medical Providers” page on the Medi-Cal Providers website.