CMS increases the payment rate for administering authorized monoclonal antibody treatments to patients with COVID-19

In addition to an overall increase, the payment rate goes up by $300 when the treatment is provided in a beneficiary’s home.

CMS has provided a 45% boost in payment to providers that administer monoclonal antibodies to beneficiaries who have COVID-19.

Starting May 6, payment increased from $310 to $450 for most healthcare settings. Payment also rose to $750 in instances when the treatment is administered in a beneficiary’s home, including temporary lodging such as a hotel. Regardless of setting, beneficiaries will not owe out-of-pocket costs for the treatment.

In a statement, CMS wrote, “These higher national average payment rates reflect additional information provided to CMS about the costs of providing these services in a safe and timely manner, such as clinical staff and personal protective equipment. This action also means Medicare payments to providers and suppliers will be more aligned to their costs to administer these products.”

Input that led to the payment increase came from the home health and ambulatory infusion industries, among other stakeholder groups.

Medicare no longer is paying for one specific monoclonal antibody treatment, bamlanivimab, when administered alone. That change stemmed from the FDA’s revocation of the treatment’s emergency use authorization. Combination treatments still are covered.

For more information and resources on administering these treatments, see the monoclonal antibody COVID-19 infusion webpage and the coding resources page for COVID-19 vaccines and treatments.