Apple Health (Medicaid) Provider Alert
Attention providers:
What changed?
Effective for dates of service on and after April 16, 2021, the Health Care Authority (HCA) no longer pays for COVID-19 monoclonal antibody bamlanivimab (HCPCS codes Q0239 and M0239).
On April 16, 2021, the Food & Drug Administration (FDA) revoked the emergency use authorization (EUA) for bamlanivimab, when administered alone, due to a sustained increase in COVID-19 viral variants in the U.S. that are resistant to this antibody therapy. The FDA determined that the known and potential benefits of bamlanivimab, when administered alone, no longer outweigh the known and potential risks.
HCA has published a revised COVID-19 monoclonal antibodies policy to reflect this change.
COVID-19 Fee Schedule
HCA also revised the Emergency COVID-19 fee schedule, dated April 16, 2021, to reflect this change. See HCA’s Provider billing guides and fee schedules, under COVID-19.
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