Module 4: Reimbursement
Federal Response to COVID-19: Therapeutics Clinical Implementation Guide (Outpatient Administration Guide for Healthcare Providers)
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CMS website for most up to date information.
- CMS created HCPCS (Healthcare Common Procedure Coding System) code J0248 for Veklury
- J0248 represents 1mg, and you should report units to reflect the dosage you administered for each patient.
- Outpatient Billing Example: a provider administering Veklury (remdesivir) in the outpatient setting would bill J0248 for the product and could use the following CPT code for its administration:
- 96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour)
- and if needed use: 96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure).
- Medicare Part B will provide payment for the drug and its administration under the applicable Medicare Part B payment policy when you provide it in the outpatient setting, according to the FDA approval and authorization. In most cases, your patient’s yearly Part B deductible and 20% co-insurance apply.
CMS COVID-19 FAQs Veklury FAQs begin on page 146