November 23, 2020
Updated May 28, 2021
Update: As of April 16, 2021, the U.S. Food and Drug Administration revoked the emergency use authorization for bamlanivimab when used along to treat COVID-19. It is still authorized for use in combination with estesevimab.
Providers receiving bamlanivimab for free should not bill for the product
Blue Cross and Blue Shield of Texas (BCBSTX) continues to provide access to medically necessary care for the treatment of COVID-19. The U.S. Food and Drug Administration granted Emergency Use Authorizaton (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