CMS Increases Medicare Payment for COVID-19 Monoclonal Antibody Infusions
As part of the ongoing response to address the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) has increased the Medicare payment rate for administering monoclonal antibodies to treat beneficiaries with COVID-19, continuing coverage under the Medicare Part B COVID-19 vaccine benefit. Beneficiaries pay nothing out of pocket, regardless of where the service is furnished, including in a physician's office, health care facility, or at home.
Effective May 6th, the national average payment rate will increase from $310 to $450 for most health care settings. In support of providers’ efforts to prevent the spread of COVID-19, CMS will also establish a higher national payment rate of $750 when monoclonal antibodies are administered in the beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging (e.g., hotel/motel, cruise ship, hostel, or homeless shelter).
The new national payment rate for at-home administration of monoclonal antibodies accounts for increased costs associated with the one-on-one nature of this care model. These higher national average payment rates reflect additional information provided to CMS about the costs of providing these services in a safe and timely manner, such as clinical staff and personal protective equipment (PPE). This action also means that Medicare payments to providers and suppliers will be more aligned to their costs to administer these products.
Members should also note the recent Food and Drug Administration (FDA) revocation of the emergency use authorization (EUA) for bamlanivimab when used alone and recommendations to use this specific therapy in conjunction with others moving forward, as it is not effective alone against new strains of COVID-19.
CMS is updating the set of toolkits for providers, states, and insurers to help the health care system swiftly administer monoclonal antibody treatment with these new Medicare payment rates on the Monoclonal Antibody COVID-19 Infusion webpage.
In addition, CMS is updating coding resources for providers on the COVID-19 Vaccines and Monoclonal Antibodies webpage.
For additional clinical information about COVID-19 monoclonal antibodies, please visit:
- National Institutes of Health (NIH) Anti-SARS-CoV-2 Monoclonal Antibodies webpage
- NIH Therapeutic Management of Adults With COVID-19 webpage
Contact: Meg Everett, email@example.com, 518-929-9342