2025 HCPCS code M0243
(Active) Effective Date: N/A Revision Date: N/A Medication Administration - Intravenous infusion or subcutaneous injection Miscellaneous Medical Services Feed
Administration of casirivimab and imdevimab via intravenous infusion or subcutaneous injection, including post-administration monitoring.
Modifiers may apply depending on the circumstances of service.Consult payer-specific guidelines for allowed modifiers.
Medical necessity for casirivimab and imdevimab administration is determined by the patient's clinical presentation, risk factors for severe COVID-19, and the provider's assessment of the benefit versus risk of treatment.Documentation of the patient's medical condition is required to support the medical necessity of the administration.
The provider is responsible for discussing the need for the treatment with the patient, preparing the solution according to manufacturer instructions, administering the drug via the appropriate route (IV infusion or subcutaneous injection), and monitoring the patient for adverse reactions for at least one hour post-administration.
In simple words: The doctor gives you a medicine called casirivimab and imdevimab through an IV drip or an injection under your skin. They also watch you for a while afterward to make sure you're okay. This medicine is used to treat mild to moderate COVID-19 or to prevent it if you've been exposed to the virus.
This HCPCS code covers the administration of the monoclonal antibody combination casirivimab and imdevimab.The administration can be via intravenous infusion or subcutaneous injection. The procedure includes preparation of the solution (bringing to correct temperature, inspecting vials, diluting for infusion or drawing into syringes for injection), administration of the drug (setting up equipment for infusion, inserting needle/catheter, starting infusion and setting drip rate, or performing subcutaneous injection), and post-administration monitoring of the patient (typically for an hour). The recommended dosage is 600 mg of casirivimab and 600 mg of imdevimab, administered as an IV infusion or via subcutaneous injection using four 2.5 mL syringes. This treatment is typically used for mild to moderate COVID-19 or as post-exposure prophylaxis (PEP) for individuals at risk of severe COVID-19.
Example 1: A patient presents to the clinic with mild COVID-19 symptoms. The physician orders casirivimab and imdevimab to be administered via IV infusion. The nurse prepares the solution, administers the infusion, and monitors the patient for 1 hour post-infusion., A patient who is immunocompromised and was recently exposed to COVID-19 receives casirivimab and imdevimab as post-exposure prophylaxis. The medication is administered via subcutaneous injection in four separate sites., A patient is hospitalized with moderate COVID-19. The physician orders casirivimab and imdevimab to be administered intravenously.The hospital pharmacist prepares the medication, the physician administers the IV infusion, and a nurse monitors the patient for several hours following administration.
Detailed patient history including COVID-19 symptoms, date of symptom onset, relevant comorbidities and immunodeficiencies; documentation of the preparation and administration of the medication; documentation of post-administration monitoring; and any adverse reactions experienced by the patient.
** This code represents the administration of the drug only. Separate codes may apply for the supply of the medication. Always refer to the most current payer guidelines for reimbursement policies.
- Payment Status: Active
- Specialties:Infectious Disease, Internal Medicine, Emergency Medicine
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Urgent Care Facility