Monoclonal EUA for Protection against Covid-19

https://www.cms.gov/files/document/COVID-19-toolkit-issuers-MA-plans.pdf

https://www.cms.gov/medicare/covid-19/monoclonal-antibody-covid-19-infusion

Monoclonal EUA for Protection against Covid-19

On December 8, 2021, the FDA issued an Emergency Use Authorization (EUA) for the administration of AstraZeneca’s two-drug Evusheld monoclonal antibody therapy for the prevention of COVID-19 in certain adults.

The combination monoclonal antibiotic therapy consisting of tixagevimab with cilgavimab is authorized as a pre-exposure option for patients over the age of 12 who weigh at least 88 pounds and have either of the following:

 The patient has moderate to severe immunocompromised systems due to medical conditions or treatments that may prevent an effective COVID-19 vaccination or;  The patient exhibited an adverse reaction to previous COVID-19 vaccinations, indicating that additional vaccines following vaccine schedules are not recommended. The EUA indicates

Evusheld may be administered at least two weeks following vaccination.

Additionally, the patient must not currently have COVID-19 and should not have known recent exposure to COVID-19. A provider may administer an Evusheld dose, consisting of two sequential intramuscular injections (one for each drug), as an option for patients who should not, for conditions outlined in the EUA, take currently available COVID-19 vaccines.

The FDA published a Frequently Asked Question (FAQ) document on Evusheld. It is available through the following link:

https://www.fda.gov/media/154703/download?utm_medium=email&utm_source=govdelivery

Code  CPT Long Descriptor 

Payment Allow after 05/06/2021  Effective Date 

Q0220 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 300 mg $ 0.01  12/08/2021 

M0220 Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), includes injection and post administration monitoring $ 150.50  12/08/2021 

(continues next page)