Module 4: Reimbursement

CMS Resources:

• CMS COVID-19 Monoclonal Antibodies
  
• CMS COVID-19 toolkits
  
• Guidance for the Expiration of the COVID-19 Public Health Emergency (PHE) 
  
• Oral Antiviral NDC Numbers:
  
• Paxlovid: 0069-1085-06, 0069-1085-30, 0069-0345-06, 0069-0345-30
  
• Reduced Dose (Renal) Paxlovid: 0069-1101-20
  
• Lagevrio (molnupiravir): 0006-5055-06, 0006-5055-07 
  
• Veklury (remdesivir) NDC Numbers: 61958-2901-2 (lyophilized power for injection), 61958-2902-2 (aqueous-based solution for injection)

Continue to check CMS website for most up to date information.

Veklury Billing

• 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