CMS Announces Increase in Medicare Payments for COVID-19 Monoclonal Antibody Infusions

Effective May 6, 2021, Medicare increased its payment rates for administering monoclonal antibodies to treat beneficiaries with COVID-19.  The national average payment rate increased from $310 to $450 for most health care settings.  CMS announced that it also set a higher national payment rate of $750 when monoclonal antibodies are administered in the beneficiary’s home, including the beneficiary’s permanent residence or temporary lodging (e.g., hotel/motel, cruise ship, hostel, or homeless shelter).  CMS said Medicare beneficiaries pay nothing out of pocket, regardless of where the service is provided – including in a physician’s office, health care facility, or at home.

CMS made the announcement via a MLN Connects Newsletter—Special Edition on May 6, 2021.  In the Special Edition, CMS also advised providers to stay tuned for updates to its set of COVID-19 Toolkits for providers, states and insurers to help the health care system swiftly administer monoclonal antibody treatment with these new Medicare payment rates. The updated monoclonal toolkit will be made available on the CMS.gov webpage for COVID-19 Vaccine Policies & Guidance. In addition, CMS said it will update provider coding resources applicable to the monoclonal antibody infusions on the webpage for COVID-19 Vaccines and Monoclonal Antibodies.