Update to Texas Medicaid and CHIP Coverage for Monoclonal Antibody Therapy Procedure Code Q0222 for the Treatment of COVID-19

Date: February 2, 2023
 
Attention: All Providers

Effective date: August 15, 2022

Providers 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: Effective August 15, 2022, payment allowance was added for COVID-19 Monoclonal Antibody Therapy Q0222 Injection, Bebtelovimab, 175 mg claims.

How this impacts providers:

• On November 30, 2022, the U.S. Food and Drug Administration (FDA) announced that bebtelovimab is no longer authorized in any U.S. region due to lack of effectiveness against Omicron sub-variants BQ.1 and BQ.1.1. Therefore, providers may no longer administer bebtelovimab to treat COVID-19 until further notice from the FDA.
• Before August 15, 2022, procedure code Q0222 was not assigned a rate and processed as ‘Informational,’ as the drug was exclusively supplied free of charge to providers by the federal or state government. Supply of this drug was transitioned to commercial sale prior to the FDA’s announcement, and providers should include the product code Q0222 on claims for dates of service from August 15, 2022, through November 29, 2022, only when the drug was purchased commercially.
• If the product was received from the government, the provider should only bill for the administration of the product and must not include the product code on claims for those dates of service. The purchase invoice for Bebtelovimab must be maintained in the provider’s records and claims may be subject to retrospective review to verify supply source.
• Claims submitted for dates of service from August 15, 2022, through November 29, 2022, that include procedure code Q0222, when the product was supplied by the federal or state government, must be voided and rebilled for the administration only. Payment received for a government-provided product is considered an overpayment and is subject to recoupment.
  

Next steps for providers: Texas Children's Health Plan will reprocess claims by March 11, 2023, if applicable, for procedure code Q0222 with dates of service from August 15, 2022, through November 29, 2022, for appropriate payment and claims processing. Eligible providers may receive an additional payment. Providers are not required to appeal the claims unless they are denied for other reasons after the claims reprocessing is complete.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers