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. 

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 HCPCS Code J0248

Your MAC wants to provide guidance for billing HCPCS code J0248 to prevent impacts to your claims processing.

Submit your claims with:

• VEKLURY™ (remdesivir) product code (HCPCS code J0248)
  • Refer to the Remdesivir FDA label (PDF) for additional information about the product
• ICD-10 code U07.1 (COVID-19) and/or J12.82 (Pneumonia due to coronavirus disease 2019)
• In addition to the product HCPCS 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 for administration information
• Units administered for patient:
  • HCPCS code J0248 represents 1mg and units should be adjusted to reflect dosage administered for each patient
  • Price per unit set as $5.512 (effective from December 23, 2021 to March 31, 2022)

Claims submitted with dates of service on or after December 23, 2021, will be held until the claims processing systems are updated.