Revised policy for therapies for COVID-19

Washington State Health Care Authority sent this bulletin at 01/20/2022 02:09 PM PST

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Apple Health (Medicaid) Provider Alert

Attention providers

What changed?

The Health Care Authority (HCA) has updated its COVID-19 therapies policy with information regarding new COVID-19 monoclonal antibodies and Remdesivir.

New COVID-19 monoclonal antibodies

Retroactive for dates of service on and after December 8, 2021, providers may bill HCA for the following monoclonal antibody treatments:

HCPC code	Short Description
Q0220	Tixagev and cilgav, 300 mg
M0220	Tixagev and cilgav inj
M0221	Tixagey and cilgay inj hm

Remdesivir (HCPCS code J0248)

Retroactive for dates of service on and after December 23, 2021, HCA may consider Remdesivir to be medically necessary when prescribed for:

Adults and pediatric patients 12 years of age or older for the treatment of coronavirus disease (COVID-19)
The treatment of pediatric patients weighing at least 3.5 kg but less than 39.99 kg or pediatric patients 11 years of age or younger weighing at least 3.5 kg with suspected or laboratory confirmed COVID-19 for whom use of an intravenous (IV) agent is clinically appropriate

See Therapies for COVID-19 for more information regarding the policy and procedure codes involved.

COVID-19 Fee Schedule

HCA revised the Emergency COVID-19 Fee Schedule. See HCA’s Provider billing guides and fee schedules, under COVID-19.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.