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Last Modified: 8/30/2022 Location: FL, PR, USVI Business: Part A, Part B

Billing Veklury (remdesivir) antiviral medication in outpatient settings

CMS created the new HCPCS code J0248 for Veklury (remdesivir) antiviral medication. This code is effective for dates of service on or after December 23, 2021, when administered in outpatient settings. CMS released this information in the MLN Connects Special Edition for Friday, January 7, 2022 external link.

Background

Veklury (remdesivir) is FDA approved for the treatment of COVID-19 in hospitalized patients. The FDA label states that Veklury should only be administered in a hospital or in a healthcare setting capable of providing acute care comparable to inpatient hospital care. There are various U.S. guideline recommendations on the role of remdesivir. Following the recent statement from the National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel regarding therapies for the COVID-19 Omicron variant, CMS created HCPCS code J0248 for Veklury (remdesivir) antiviral medication when administered in an outpatient setting. The payment for Veklury (remdesivir) was included in the bundled payment for inpatient treatment plus the New COVID-19 Treatments Add-on Payment.
Code J0248 is available for use by all payers and is payable by Medicare in the outpatient setting for dates of service on or after December 23, 2021.

Outpatient claim requirements for J0248

First Coast wants to provide guidance for billing J0248 to prevent impacts to your claims processing.
Submit your claims with:
Veklury (remdesivir) product code (J0248)
Refer to the Remdesivir FDA label external pdf file for additional information about the product
ICD-10 code U07.1 (COVID-19) or J12.82 (Pneumonia due to coronavirus disease 2019)
For dates of services on or after April 1, ICD-10 codes Z283.10 (Unvaccinated for COVID-19) or Z283.11 (Partially vaccinated for COVID-19) are also accepted
In addition to the product code J0248, use the following CPT code for administration:
96365 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour)
And if needed use:
96366 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure)
For Part A claims:
Appropriate type of bill (TOB)
Appropriate revenue codes
For Part B claims:
Appropriate place of service (POS) code
Refer to the NIH COVID-19 Treatment Guidelines Panel external link for administration information
Units administered for patient:
J0248 represents 1mg and units should be adjusted to reflect dosage administered for each patient
Price per 1 mg unit set as $5.512 (effective from December 23, 2021, to June 30, 2022)
Claims submitted with dates of service on or after December 23, 2021, will be held until the claims processing systems are updated.
For additional questions, please contact medicalaffairs@guidewellsource.com.

Additional information

Please visit First Coast’s Coronavirus (COVID-19) webpage for additional information about the public health emergency (PHE).
CMS established the New COVID-19 Treatments Add-on Payment (NCTAP) for eligible discharges under the Medicare Inpatient Prospective Payment System (IPPS) effective until the end of the PHE. Eligible claims should have an ICD-10-CM diagnosis code U07.1 (COVID-19) and one of the following:
ICD-10-PCS codes for remdesivir (Veklury), COVID-19 convalescent plasma, or baricitinib (Olumiant).
National Drug Codes (NDC) for nirmatrelvir and molnupiravir.
Visit the NCTAP external link webpage for more information.
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.