Monoclonal Antibody Procedure Code Q0221 for Treatment of COVID-19 Added to Texas Medicaid Benefits

Date: July 5, 2022Attention: All Providers  Effective Date: February 24, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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 24, 2022, the Centers for Medicare and Medicaid Services (CMS) created a new procedure code, Q0221, reflecting a revised U.S. Food and Drug Administration (FDA) emergency use dosage for AstraZeneca Evusheld (tixagevimab co-packaged with cilgavimab). How this impacts providers: Evusheld is a pre-exposure prophylaxis to prevent COVID-19 in adults and pediatric individuals (12 years of age and older weighing at least 40 kg):

• Who are notcurrently infected with SARS-CoV-2 and who have not had known recent exposure to an individual infected with SARS-CoV-2, AND
  • Who have moderate to severe immune compromise because of 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 because of a history of severe adverse reaction (e.g., severe allergic reaction) to a COVID-19 vaccine(s) and/or COVID-19 vaccine component(s).

The previous lower dosage was 150 mg of tixagevimab and 150 mg of cilgavimab. However due to decreased neutralization activity against certain COVID–19 subvariants, the FDA has increased the emergency use authorization (EUA) dosage to 300 mg of tixagevimab and 300 mg of cilgavimab, for a current total of 600 mg. Procedure code M0220 (Administration of Evusheld in a long-term care facility, office, or outpatient hospital) can be billed with procedure code Q0221. Procedure code M0221 (Administration of Evusheld inside a patient’s home) can be billed in the home setting with procedure code Q0221. 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.