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    v1.0.30
    OpenPayerBilling CodesMiscellaneous Medical ServicesHCPCS hcpcs-m0220-tixagevimab-cilgavimab-pre-exposure-prophylaxis
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    HCPCS Level II M0220: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

    HCPCS Level II code M0220 describes administration of the monoclonal antibody combination tixagevimab and cilgavimab for pre-exposure prophylaxis against SARS-CoV-2 in eligible adults and pediatric patients (≥12 years and ≥40 kg), and includes the injection procedure and post-administration monitoring; service type: monoclonal antibody injection for prophylaxis; typical site of service: outpatient clinic, infusion center, or other ambulatory care setting where injections and post-administration observation are provided.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult or adolescent (age ≥12 years and weight ≥40 kg) with either moderate to severe immunocompromise or a documented history of severe allergic reaction to a COVID-19 vaccine or vaccine component, presenting for pre-exposure prophylaxis against SARS‑CoV‑2. The patient is scheduled for administration of M0220 (tixagevimab and cilgavimab) in an outpatient infusion clinic, primary care office, ambulatory infusion suite, or community pharmacy that offers long‑acting monoclonal antibody prophylaxis. Clinical workflow: the patient arrives for a pre‑scheduled appointment, identification and consent are confirmed, a brief pre‑administration assessment (vital signs, review of allergies, medication list, and current symptoms) is completed, and documentation of indication (immunocompromised status or vaccine contraindication) is verified in the chart. The injection is administered intramuscularly per product instructions, the encounter includes post‑administration monitoring for adverse reactions (observation period typically 15–30 minutes), and the injection and monitoring are documented in the medical record. Billing uses M0220 to represent the drug administration and included monitoring; applicable facility and professional claims may append modifiers for special circumstances such as increased procedural complexity, anesthesia, or bilateral procedures when relevant. Medication reconciliation, adverse event counseling, and scheduling of follow‑up or repeat dosing per current clinical guidance are completed before discharge.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96372Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular)Commonly used for billing the professional administration service when pharmacy or clinician bills separately for administration of M0220.
    99213Office or other outpatient visit, established patient, low to moderate complexityTypical visit level for evaluation and management before or after administration in an outpatient clinic.
    99024Postoperative follow-up visit, included in global serviceNot typically used but listed here for documentation of routine post‑procedure follow‑up when payer policy references bundled services.
    99406Smoking and tobacco use cessation counseling, intermediateIncluded as an example of ancillary counseling CPTs that may be billed separately when delivered during the visit (use only if applicable and documented).
    81002Urinalysis, non‑automated, without microscopyExample of ancillary tests that may be performed pre‑visit; include only if performed and separately billable.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207Q00000X
    208D00000X
    163W00000X
    207L00000X
    2080P0008X
    246ZC0007X
    103TH0100X

    Related ICD-10-CM Codes

    28 rows

    ICD-10-CM CodeDescription
    B20Human immunodeficiency virus [HIV] disease
    B97.89Other viral agents as the cause of diseases classified elsewhere
    C90.00Multiple myeloma not having achieved remission
    C91.00Acute lymphoblastic leukemia not having achieved remission
    C92.00Acute myeloblastic leukemia, not having achieved remission
    C95.00Acute leukemia of unspecified cell type not having achieved remission
    D47.Z9Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue
    D61.9Aplastic anemia, unspecified
    D70.9Neutropenia, unspecified
    D73.9Disease of spleen, unspecified

    Showing 1–10 of 28

    Related Codes

    HCPCS-M0075-CELLULAR-THERAPY-PROCESSING-PROVISION

    HCPCS Level II M0075: Cellular Therapy

    HCPCS-M0076-PROLOTHERAPY-INJECTION-THERAPY

    HCPCS Level II M0076: Prolotherapy

    HCPCS-M0100-INTRAGASTRIC-HYPOTHERMIA-GASTRIC-FREEZING

    HCPCS Level II M0100: Intragastric Hypothermia (Gastric Freezing)

    HCPCS-M0201-IN-HOME-VACCINE-ADMINISTRATION

    HCPCS Level II M0201: In-Home Vaccine Administration

    HCPCS-M0221-TIXAGEVIMAB-CILGAVIMAB-PRE-EXPOSURE-PROPHYLAXIS-HOME-ADMINISTRATION

    HCPCS M0221: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

    HCPCS-M0222-BEBTELOVIMAB-INTRAVENOUS-INJECTION-MONITORING

    HCPCS Level II M0222: Bebtelovimab Intravenous Injection with Monitoring

    HCPCS-M0223-BEBTELOVIMAB-INTRAVENOUS-INJECTION-HOME-MONITORING

    HCPCS M0223: Intravenous Bebtelovimab with Home Monitoring

    HCPCS-M0224-PEMIVIBART-PRE-EXPOSURE-PROPHYLAXIS-INFUSION

    HCPCS M0224: Pemivibart Intravenous Infusion for Pre-Exposure Prophylaxis

    HCPCS-M0233-TOCILIZUMAB-INFUSION-COVID19-HOSPITALIZED-ADULTS

    HCPCS Level II M0233: Tocilizumab-aazg IV Infusion, First Dose

    HCPCS-M0234-TOCILIZUMAB-INFUSION-HOSPITALIZED-COVID19

    HCPCS Level II M0234: Tocilizumab Infusion for Hospitalized Adults with COVID-19

    Showing 1–10 of 27

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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