Monoclonal Antibody Therapy Procedure Codes for COVID-19 Treatment Added to Texas Medicaid Benefits

Date: February 2, 2022 Attention: All Providers Effective Date: December 8, 2021Providers 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: On December 8, 2021, the U.S. Food and Drug Administration issued an Emergency Use Authorization (EUA) for the AstraZeneca product Evusheld (tixagevimab co-packaged with cilgavimab), a SARS-CoV-2 spike protein-directed attachment inhibitor for pre-exposure prophylaxis for prevention of COVID-19 in adults and pediatric individuals (12 years of age and older weighing at least 40 kg):

• Who are not currently infected with SARS-CoV-2 and who have not had a known recent exposure to an individual infected with SARSCoV-2; and
• Who have moderate to severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments and may not mount an adequate immune response to COVID-19 vaccination; or
• For whom vaccination with any available COVID-19 vaccine, according to the approved or authorized schedule, is not recommended due to a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID19 vaccine component(s).

How this impacts providers: For dates of service beginning December 8, 2021, procedure codes M0220 (Administration of AstraZeneca’s Evusheld in a healthcare setting) and M0221 (administration of AstraZeneca’s Evusheld in the home or residence) are added benefits in Texas Medicaid. Procedure codes M0220 and M0221 are applicable only for diagnosis code Z20822. Procedure code M0220 is a benefit for the following providers and places of service:

Place of Service	Provider Types
Nursing Home	Physician, Clinic/Group Practice
Office	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Group, Clinic/Group Practice
Outpatient Hospital	Hospital

Procedure code M0221 is a benefit for the following providers and places of service:

Place of Service	Provider Types
Home	Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Physician, Physician Group, Clinic/Group Practice, Home Health Agency, CCP Provider

  Effective for dates of service on or after December 8, 2021, procedure code Q0220 (AstraZeneca’s Evusheld Product) is added as an informational code for Texas Medicaid while the drug is being distributed to providers free of charge. Next steps for providers: Prescribers should share this communication with their staff. If you have any questions, please email the TCHP Pharmacy Department:  TCHPpharmacy@texaschildrens.orrg For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.