Addition of Bamlanivimab and Casirivimab/Imdevimab as a Texas Medicaid Benefit and for FDA Emergency Use Authorization

Attention: All Providers Effective Date: December 15, 2020Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: Texas Children’s Health Plan would like to inform network providers that Texas Medicaid has added two medications, bamlanivimab and casirivimab/imdevimab, as outpatient benefits in response to the COVID-19 Emergency Use Authorization (EUA). Both are monoclonal antibodies used to treat COVID-19 and should be administered within 10 days of symptom onset. Qualifications to receive this medication include the following:

Mild to moderate coronavirus disease (COVID-19) with a diagnosis of U07.1
Patients twelve years old and older
Patients with a weight of at least 40 kg or 88 pounds
Patients that are at a high risk of progressing to severe COVID-19 or requiring hospitalization

These medications are not recommended for patients that have been hospitalized due to COVID-19 or require oxygen therapy. How this impacts providers: The following codes will be set up as payable:

Bamlanivimab (Q0239) and the administration of bamlanivimab (M0239). It is an allowable drug for dates of service on or after November 9, 2020.
Casirivimab/imdevimab (Q0243) and the administration of casirivimab/imdevimab (M0243). It is an allowable drug for dates of service on or after November 21, 2020. Casirivimab and imdevimab must be administered together.

Next steps for providers: Providers should share this communication with their staff. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers