M0224
ActivePemivibart 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
MUE — Medically Unlikely Edits
Maximum units of M0224 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 1 |
| Practitioner Services | 1 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NCCI Edits
The following codes cannot be billed together with M0224 without appropriate documentation.
| Column 2 Code | Modifier |
|---|---|
| E0781 | Modifier may bypass edit |
| G0463 | Modifier may bypass edit |
| G0471 | Modifier may bypass edit |
Source: CMS National Correct Coding Initiative (NCCI)
Change History
Quarterly changes published by CMS. Revisions may affect the code description, coverage, or rate — review each quarter's changes before submitting claims.
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New Code 2024-Q1Pemivibart infusion