CMS to cover monoclonal antibody infusions

Nov. 12, 2020

The Centers for Medicare & Medicaid Services (CMS) announced that Medicare beneficiaries can receive coverage for monoclonal antibody infusions to treat COVID-19 with no cost-sharing during the COVID-19 Public Health Emergency (PHE), according to a press release from the agency.

CMS said its decision to cover monoclonal antibody infusions applies to bamlanivimab, which received an Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) on November 9.

CMS said it anticipates that this monoclonal antibody product will initially be given to healthcare providers at no charge. Medicare will not pay for the monoclonal antibody products that providers receive for free, but it will reimburse providers for the infusion of the product.

When healthcare providers begin to purchase monoclonal antibody products, Medicare anticipates setting the payment rate in the same way it set the payment rates for COVID-19 vaccines, such as based on 95 percent of the average wholesale price for COVID-19 vaccines in many provider settings. CMS said it will issue billing and coding instructions for healthcare providers in the coming days. 

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