The Centers for Medicare & Medicaid Services (CMS) recently announced that Medicare now offers coverage of bamlanivimab (a monoclonal antibody therapy) used to treat COVID-19 at no cost-sharing for the duration of the public health emergency (PHE). Specifically, CMS is providing coverage for:
- Infusion: The initial payment rate for administration of bamlanivimab will be $309.60 and will be geographically adjusted. CMS states this is based on one hour of infusion and post-administration monitoring in the hospital outpatient setting.
- Product: CMS says it will not provide payment for antibody products that providers receive for free, which the agency states “will be the case upon the product’s initial availability in response to the COVID-19 PHE.” However, if and when providers do begin purchasing monoclonal antibody products, the agency states it anticipates setting the payment rate at 95 percent of the average wholesale price for many health care providers, which is consistent with CMS’ vaccine payment methodologies.
CMS states this would allow a “broad range of providers and suppliers, including freestanding and hospital-based infusion centers, home health agencies, nursing homes, and entities with whom nursing homes contract for this, to administer treatment in accordance with” the emergency use authorization for the product.
Billing information is included on p. 3 of the program instruction (here again for reference). In regards to Medicare Advantage (MA), CMS states that providers who participate in an MA plan should submit claims for the administration of bamlanivimab to Original Medicare for all MA patients during 2020 and 2021.
Last, CMS reminds states that a condition of receiving the temporary increase in the Federal Medical Assistance Percentage (FMAP) of 6.2 percent under the Families First Coronavirus Response Act is that states must cover COVID-19 testing and treatments – including vaccines – for Medicaid beneficiaries without cost sharing. It further clarifies that this includes monoclonal antibody infusion and that CMS expects such services to be covered when furnished to Medicaid beneficiaries during the PHE.