Medicare
Payment Allowance Update for COVID-19 Monoclonal Antibody Therapy
Renowned drug manufacturer Eli Lilly decided to start their commercial distribution of COVID-19 monoclonal antibody therapy bebtelovimab, 175mg injection on August 15, 2022. CMS will pay $2394.00 for this product which encompasses 95% of the average wholesale price.
You might have both USG-purchased and commercially purchased products in your inventory. However, after August 15 Medicare will only entertain bills for commercially purchased products.
How would you know which is commercially purchased? It’s simple!
Check the batch # on the vial. Commercially purchased products will contain batch # D534422. You can continue the use of the same HCPCS codes
- Q0222: Injection, 175mg for the product
- M0222: Intravenous injection, includes injection and post-administration monitoring
- M0223: Intravenous injection, includes injection and post-administration monitoring in the home or residence.
No cost sharing is available (no copayment/coinsurance or deductible) through the calendar year that the COVID-19 public health emergency ends for monoclonal antibody therapies to treat COVID-19 for people with Medicare.
Source: https://www.cms.gov
Non-Compliance Letters for FY 2023 APU as a part of QRP
As a part of the Quality Reporting Program (QRP) requirement, CMS is providing letters to healthcare facilities that were out of compliance. This in turn will also affect their FY 2023 Annual Payment Update (APU).
Medicare Administrative Contractors (MACs) already sent the non-compliance letters as of July 13th, 2022. These letters were placed into facilities CASPER folders in QIES.
Facilities had a chance for submitting a reconsideration request to CMS that expired on the 11th instant.
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