The Centers for Medicare and Medicaid Services (CMS) has issued updates to the national fee schedule for vaccine administration covered under the Medicare Part B benefit. A recent MLN Matters article and related Change Request CR 14195 provide details that SNF vaccinators and billers should be review as they include new billable codes that are effective October 1, 2025, as well as codes that can be retroactively billed to January 2025.
Two key updates are as follows:
- AVTOZMA® has three billable codes for post-exposure prophylaxis or COVID-19 treatment as well as for treating rheumatoid arthritis, giant cell arthritis, polyarticular juvenile idiopathic arthritis, and systemic juvenile idiopathic arthritis. These codes are effective as of January 1, 2025.
- Note: Medicare Administrative Contractors (MACs) won’t search their history files but will adjust any claims you bring to their attention that include the three AVTOZMA® related codes Q0237, M0237, and M0238.
- CMS also is establishing a Not Otherwise Classified COVID-19 monoclonal antibody product HCPCS Level II code and associated administrative effective October 1, 2025, for billing newly FDA-approved products not yet assigned to a unique HCPCS Level II code.
Keep checking AHCA's #GetVaccinated webpage for updates and new resources as more information becomes available