Question 1

What is HCPCS code M0224?

Accepted Answer

HCPCS code M0224 is "Pemivibart infusion". Intravenous infusion, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring

Question 2

What category is M0224 in?

Accepted Answer

M0224 belongs to HCPCS Category M (Medical Services).

Question 3

When should I use HCPCS code M0224?

Accepted Answer

Use M0224 when billing for pemivibart infusion. HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is M0224 covered by Medicare?

Accepted Answer

Coverage for M0224 (Pemivibart infusion) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for M0224?

Accepted Answer

Documentation for M0224 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).