Procedure Codes M0222, M0223 & Q0222 for COVID-19 Treatments Added as Texas Medicaid & CHIP Benefits
Date: July 5, 2022Attention: All Providers Effective Date: February 11, 2022Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.Call to action: On February 11, 2022, the U.S. Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for the emergency use of bebtelovimab for the treatment of mild to moderate COVID-19 in adults and pediatric patients (age 12 and older weighing at least 40 kg):
With positive results of direct SARS-CoV-2 viral testing
Who are at high risk for progression to severe COVID-19, including hospitalization or death
For whom alternative COVID-19 treatment options approved or authorized by FDA are not accessible or clinically appropriate.
How this impacts providers: Limitations of Authorized Use
Bebtelovimab is not authorized for treatment of mild-to-moderate COVID-19 in geographic regions where infection is likely to have been caused by a non-susceptible SARS-CoV-2 variant based on available information including variant susceptibility to this drug and regional variant frequency.
Bebtelovimab is not authorized for use in patients who:
are hospitalized due to COVID-19 OR
require oxygen therapy and/or respiratory support due to COVID-19, OR
require an increase in baseline oxygen flow rate and/or respiratory support due to COVID-19 and are on chronic oxygen therapy and/or respiratory support due to underlying non-COVID19 related comorbidity.
For dates of service beginning February 11, 2022, procedure codes M0222 (Administration of Eli Lilly’s Bebtelovimab in a healthcare setting) and M0223 (Administration of Eli Lilly’s Bebtelovimab in the home or residence) are added benefits in Texas Medicaid and CHIP. Procedure codes M0222 and M0223 are applicable for diagnosis code U071.
Procedure code M0222 is a benefit for the following providers and places of service:
Procedure code M0223is a benefit for the following providers and places of service:
Place of Service
Provider Type
Home
Physician, Physician Groups, Physician Assistant, Nurse Practitioner, Clinical Nurse Specialist, Home Health Agency, Comprehensive Care Program (CCP) Providers
Effective for dates of service on or after February 11, 2022, procedure code Q0222 (Eli Lilly’s Bebtelovimab Product) is added as informational for Texas Medicaid and CHIP while the drug is being distributed to providers free of charge.
Next steps for providers: Prescribers should share this communication with their staff
If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
