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 cilgabimab) monoconal antibody therapy in the circumstances outlined below.
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) monoclonal antibody therapy as 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 not currently 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.
Effective for dates of service on or after February 24, 2022, Community First has added procedure code Q0221 (AstraZeneca’s Evusheld Product) as an informational code for Texas Medicaid and CHIP while the drug is being distributed to providers free of charge.
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
Community First has updated their systems and processes to reflect this code update.
For additional information, please contact the Provider Relations division at (210) 358- 6294 or ProviderRelations@CFHP.com.