New CPT Code for Eli Lilly’s Antibody Treatment for COVID-19
Jun 30, 2021
In November of 2020, the FDA approved Eli Lilly’s antibody treatment for COVID-19. The antibody treatment was designed to treat mild-to-moderate cases of the coronavirus in patients aged 12 or older who were at risk of developing more severe symptoms of COVID-19 or who may have been at risk of needing hospitalization.
As with the COVID-19 vaccine, the costs of the COVID-19 antibody treatment are covered by Medicare for the duration of the coronavirus pandemic and the Centers for Medicare and Medicaid Services have released CPT codes for the billing of this treatment.
What Is the Eli Lilly COVID-19 Antibody Treatment?
The Eli Lilly COVID-19 antibody treatment is a monoclonal antibody therapy that involves bamlanivimab and etesevima. It was given emergency authorization by the FDA on November 9 of 2020 as a treatment for patients who tested positive for COVID-19, were 12 years of age or older, and weighed at least 88 pounds. Bamlanivimab and etesevima were authorized by the FDA as a treatment together and bamlanivimab was authorized for use on its own, but etesevima was only ever authorized to treat COVID-19 in conjunction with bamlanivimab.
The antibody treatment isn’t a cure for COVID-19, but in clinical trials, it was shown to reduce the number of hospitalizations due to the coronavirus in patients at higher risk for progressing more severe symptoms of the virus.
The FDA revoked the treatment’s authorization in April of 2021 due to the rise of COVID-19 variants.
How Can The Antibody Treatment Be Billed?
Just like with the COVID-19 vaccines, the costs of the bamlanivimab and etesevima monoclonal antibody treatments are covered by Medicare during the COVID-19 pandemic. The treatment can be billed by healthcare providers either as a single claim or as a roster bill. The CMS expects that any healthcare providers billing for this treatment provide documentation to show that all guidelines regarding the treatment were followed, including the name of the healthcare professional who ordered the treatment for the patient.
What Are the CPT Codes for the Eli Lilly Antibody Treatment for COVID-19?
The Centers for Medicare and Medicaid Services (CMS) released the following CPT codes for billing for the bamlanivimab and etesevima antibody treatment:
The CPT code Q0245 has been assigned to the 2100 mg injections of etesevima and bamlanivimab.
The CPT code M0245 has been assigned to the intravenous infusion and the monitoring of the patient post-administration.