COVID-19 Convalescent Plasma Benefit Modified

Date: July 5, 2022Attention: All ProvidersEffective Date: December 28, 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 February 10, 2022, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the emergency use of COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies for the treatment of COVID-19 patients with immunosuppressive disease or receiving immunosuppressive treatment in either the inpatient or outpatient setting. Convalescent plasma treatment of hospitalized patients with COVID-19 has been subject to EUA since August of 2020. Subsequent scientific studies have indicated the need to modify this EUA by limiting use in immunocompromised patients. A new HCPCS code C9507 was created to describe this service (C9507 long descriptor: Fresh frozen plasma, high titer COVID-19 convalescent, frozen within 8 hours of collection, each unit). How this impacts providers:

• Effective for dates of service on or after December 28, 2021, procedure code C9507 (administration of high titer COVID-19 convalescent fresh frozen plasma in the outpatient) is a benefit. Procedure code C9507 is applicable for diagnosis code U071.
• Clients of all ages, including pregnant women and children who meet EUA criteria, may be eligible for procedure code C9507.
• Providers must follow the National Institutes of Health COVID-19 Treatment Guidelines for convalescent plasma, which can be found on the following webpage: NIH COVID convalescent plasma guidelines.
• Procedure code C9507 can be administered by the following providers and places of service:

 

Place of Service	Provider Type
Outpatient Hospital	Ambulatory surgical center
Outpatient Hospital	Hospital Providers

HHSC will cover convalescent plasma as a non-risk payment. Note: Prior authorization will not be required for procedure code C9507 in fee-for-service Next steps for providers: Prescribers 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