Revised policy for therapies for COVID-19

Washington State Health Care Authority sent this bulletin at 05/02/2023 04:52 PM PDT

May 2, 2023

Apple Health (Medicaid) Provider Alert

Attention providers

What changed?

The Health Care Authority (HCA) updated the COVID-19 therapies policy as follows:

Added information on Baricitinib, which is Food and Drug Administration (FDA)-approved for hospitalized adults requiring supplemental oxygen, noninvasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). See the Medical necessity, Clinical policy, Dosage and quantity limits, and Providers sections.
Removed tixagevimab+cilgavimab (HCPCS codes Q0220, Q0221, M0220, and M0221), retroactive to dates of service on and after January 26, 2023. This is the date the FDA revoked the emergency use authorization.
Removed outdated billing information
Added that when billing COVID-19 monoclonal antibodies in an outpatient prospective payment system (OPPS) setting, use revenue code 0636. This is retroactive to dates of service on and after January 1, 2022.

Therapies for COVID-19

For more details, see the revised Therapies for COVID-19 on HCA’s Provider billing guides and fee schedules webpage under COVID-19, Policies and billing guidance.

COVID-19 Fee Schedule

HCA revised the 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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Nondiscrimination

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.

Revised policy for therapies for COVID-19

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination