Providers Receiving Bamlanivimab for Free Should Not Bill for the Product

November 20, 2020

Blue Cross and Blue Shield of Illinois (BCBSIL) continues to provide access to medically necessary care for the treatment of COVID-19. The U.S. Food and Drug Administration granted Emergency Use Authorization (EUA)  for Eli Lilly and Company’s investigational neutralizing antibody bamlanivimab. Bamlanivimab is authorized under the EUA to treat mild to moderate COVID-19 in high-risk patients.

What’s reimbursed: The federal government is currently purchasing bamlanivimab. It’s providing bamlanivimab to states to distribute to health care providers at no cost for COVID-19 treatment. We won’t reimburse for bamlanivimab that providers received for free. Providers should not charge members for the treatment. We will reimburse for the administration of the treatment. Other medically necessary treatment for COVID-19 will be covered consistent with the terms of the member’s benefit plan. When providers begin to purchase bamlanivimab, we will update our position.

Claims coding: The Centers for Medicare & Medicaid Services identified the following codes for the bamlanivimab product and administration:

  • Q0239 – Injection, bamlanivimab-xxxx, 700 mg
  • M0239 – Intravenous infusion, bamlanivimab-xxxx, includes infusion and post-administration monitoring

The above material is for informational purposes only and is not intended to be a substitute for the independent medical judgment of a physician. Physicians and other health care providers are encouraged to use their own best medical judgment based upon all available information and the condition of the patient in determining the best course of treatment.

The information in this article is for illustrative purposes only. The actual process and coding of a patient’s medical condition will vary based on the individual circumstances and the information contained in the medical records.