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Last Modified: 10/3/2022 Location: FL, PR, USVI Business: Part A, Part B

Billing COVID-19 convalescent plasma in outpatient setting

CMS created the new HCPCS code C9507 for COVID-19 convalescent plasma for use in the outpatient setting. This code is effective for dates of service on or after December 28, 2021, when administered in an outpatient setting. CMS released this information in the MLN Connects newsletter for Thursday, February 10, 2022 external link.

Background

On December 28, 2021, the Food and Drug Administration (FDA) revised the emergency use authorization external link for COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. It’s authorized for treatment of COVID-19 in patients with immunosuppressive disease or getting immunosuppressive treatment, in the outpatient or inpatient setting.
Code C9507 is available for use in the outpatient setting for dates of service on or after December 28, 2021.

Outpatient claim requirements for C9507

We are providing the following guidance for billing C9507 to prevent impacts to your claims processing.
Submit claims with:
HCPCS code: C9507
Status Indicator: S
Ambulatory payment classification (APC): 1509
Long descriptor: Fresh frozen plasma, high titer COVID-19 convalescent, frozen within 8 hours of collection, each unit
Short descriptor: COVID-19 convalescent plasma
Appropriate diagnosis coded to highest level of specificity
Appropriate type of bill:
12x, 13x, or 85x
Appropriate revenue code:
0383, 0390 or 0392
Payment rate: $750.50 per unit
Beneficiary cost sharing will apply to COVID-19 convalescent plasma product code.
Billing and payment information can be found on the Hospital Outpatient Prospective Payment System (OPPS) webpage external link and will be added to the April 2022 Addenda B on the OPPS Addendum A and Addendum B Updates webpage external link.

Additional information

Please visit our Coronavirus (COVID-19) webpage for additional information about the public health emergency.
First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.