On December 9, CMS posted updates to FAQs and an infographic about coverage and payment for monoclonal antibodies to treat COVID-19. The FDA has issued an Emergency Use Authorization (EUA) for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients with positive COVID-19 test results who are at high risk for progressing to severe COVID-19 and/or hospitalization. The CMS FAQs include general payment and billing guidance for these products, including questions on different setting types. The infographic has key facts about expected Medicare payment to providers and information about how Medicare beneficiaries can receive these innovative COVID-19 treatments with no cost-sharing during the public health emergency (PHE).

CMS’ November 10, 2020 announcement about coverage of monoclonal antibody therapies allows a broad range of providers and suppliers, including nursing homes, and entities with whom nursing homes contract, to administer this treatment in accordance with the FDA EUA, and bill Medicare to administer these infusions. Currently, two monoclonal antibody therapies have received EUA’s for treatment of COVID-19.

For more information:

• List COVID-19 Monoclonal Antibody Infusion Billing Codes, Payment Allowances and Effective Dates
• Monoclonal Antibody COVID-19 Infusion Program Instruction
• CMS COVID-19 Vaccine Provider Toolkit
• Therapeutics Coverage Infographic
• Section BB of the FAQs: Billing and Payment for COVID-19 Monoclonal Antibody Treatments
• Monoclonal Toolkit and Program Guidance