HCPCS M0221: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

HCPCS Level II code M0221 describes administration of the monoclonal antibody combination tixagevimab and cilgavimab for pre-exposure prophylaxis in eligible adults and pediatric patients (age ≥12 years and ≥40 kg) with no known SARS‑CoV‑2 exposure; the service includes the injection and post-administration monitoring provided in the home or residence (including a home temporarily designated provider-based during the COVID‑19 public health emergency), and is billed as an outpatient injectable prophylaxis service for immunocompromised patients or those with contraindications to COVID‑19 vaccination.

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Clinical & Coding Specifications

Clinical Context

A 58-year-old patient with a history of renal transplant on chronic immunosuppressive therapy is scheduled to receive pre-exposure prophylaxis with tixagevimab and cilgavimab at home. The patient has no known SARS-CoV-2 exposure and is not a candidate for COVID-19 vaccination due to a prior anaphylactic reaction to a vaccine component. A home health nurse performs pre-visit screening for active COVID-19 symptoms, verifies patient identity and informed consent, confirms weight ≥ 40 kg and age ≥ 12 years, and reviews relevant allergies and current medications. The nurse reconstitutes and prepares the intramuscular injections, administers the doses per manufacturer guidance, monitors the patient on site for the required post-administration observation period, documents lot numbers and injections in the medical record, and communicates administration details to the patient’s transplant clinic. Billing occurs using M0221 with appropriate modifier(s) to indicate site of service or circumstances (for example, home administration or provider-based status). Typical documentation includes indication (immunocompromised state or vaccine contraindication), consent, medication dosing and lot numbers, observation time, and any adverse events.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly used for billing the administration component when payer requires a CPT alongside HCPCS drug code for injection administration tracking
`99024`	Postoperative follow-up visit, included in global service (routine follow-up)	May be used for routine post-administration follow-up when payer guidance allows reporting of brief follow-up visits
`99499`	Unlisted evaluation and management service	Use when a specific E/M or care coordination service related to the prophylaxis visit cannot be reported with existing codes and is payer-acceptable
`G0378`	Physician administration of medication in home setting (Medicare specific, if applicable)	Used when Medicare or other payers require a home infusion/administration code to document clinician-administered medication in the home
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit	Use to report special supplies used for home administration, per payer rules

Related Modifiers

5 rows

Modifier	Description	When to Use
32	Modifier 32 (Mandated Services) indicates that a CPT-coded service was required by a third party—such as an insurer, school, state agency, or court. The AMA defines it as denoting services mandated…	- Use Modifier 32 when a service or procedure was explicitly mandated by a third party (for example an insurer requiring a second opinion, a school requiring a sports physical, a state agency or…
92	Modifier 92 (Alternative Laboratory Platform Testing) is used when laboratory tests are performed with single‑use, disposable, portable kits or transportable instruments. The AMA defines it for tests…	- Use modifier 92 when a laboratory test is performed using a single‑use, disposable analytical device or kit (an alternative laboratory platform) that is portable and may be taken to or near the…
[object Object]
P4	Modifier P4 indicates the patient is ASA Physical Status IV — a patient with severe systemic disease that is a constant threat to life. It is assigned by the anesthesia provider and must be supported…	- When to apply: Use modifier P4 only on anesthesia CPT codes (00100–01999) to indicate ASA Physical Status IV — a patient with severe systemic disease that is a constant threat to life (examples:…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code
363A00000X
207R00000X
207K00000X
163W00000X
209800000X
101YP2500X
3416S0300X
2082S0105X

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-M0220-TIXAGEVIMAB-CILGAVIMAB-PRE-EXPOSURE-PROPHYLAXIS

HCPCS Level II M0220: 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.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.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.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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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Commonly used for billing the administration component when payer requires a CPT alongside HCPCS drug code for injection administration tracking
`99024`	Postoperative follow-up visit, included in global service (routine follow-up)	May be used for routine post-administration follow-up when payer guidance allows reporting of brief follow-up visits
`99499`	Unlisted evaluation and management service	Use when a specific E/M or care coordination service related to the prophylaxis visit cannot be reported with existing codes and is payer-acceptable
`G0378`	Physician administration of medication in home setting (Medicare specific, if applicable)	Used when Medicare or other payers require a home infusion/administration code to document clinician-administered medication in the home
`99070`	Supplies and materials provided by the physician over and above those usually included with the office visit	Use to report special supplies used for home administration, per payer rules

Related Modifiers

5 rows

Modifier	Description	When to Use
32	Modifier 32 (Mandated Services) indicates that a CPT-coded service was required by a third party—such as an insurer, school, state agency, or court. The AMA defines it as denoting services mandated…	- Use Modifier 32 when a service or procedure was explicitly mandated by a third party (for example an insurer requiring a second opinion, a school requiring a sports physical, a state agency or…
92	Modifier 92 (Alternative Laboratory Platform Testing) is used when laboratory tests are performed with single‑use, disposable, portable kits or transportable instruments. The AMA defines it for tests…	- Use modifier 92 when a laboratory test is performed using a single‑use, disposable analytical device or kit (an alternative laboratory platform) that is portable and may be taken to or near the…
[object Object]
P4	Modifier P4 indicates the patient is ASA Physical Status IV — a patient with severe systemic disease that is a constant threat to life. It is assigned by the anesthesia provider and must be supported…	- When to apply: Use modifier P4 only on anesthesia CPT codes (00100–01999) to indicate ASA Physical Status IV — a patient with severe systemic disease that is a constant threat to life (examples:…
82	Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…	- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…

Related Provider Taxonomies

8 rows

Taxonomy Code
363A00000X
207R00000X
207K00000X
163W00000X
209800000X
101YP2500X
3416S0300X
2082S0105X

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-M0220-TIXAGEVIMAB-CILGAVIMAB-PRE-EXPOSURE-PROPHYLAXIS

HCPCS Level II M0220: 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.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.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.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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Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

HCPCS M0221: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

References

HCPCS M0221: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

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HCPCS M0221: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What service does HCPCS code M0221 represent?

Which patients are eligible for M0221 and what documentation is typically required?

Do I need to add modifiers when billing M0221 and which ones might apply?

Are there related CPT/HCPCS codes I should consider when submitting claims with M0221?

Which payers are noted as covering M0221 and what payer-specific issues are highlighted?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related Codes

What service does HCPCS code M0221 represent?

Which patients are eligible for M0221 and what documentation is typically required?

Do I need to add modifiers when billing M0221 and which ones might apply?

Are there related CPT/HCPCS codes I should consider when submitting claims with M0221?

Which payers are noted as covering M0221 and what payer-specific issues are highlighted?

References