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HCPCS M0224: Pemivibart IV Infusion for Pre-Exposure Prophylaxis
HCPCS Level II code M0224 represents the intravenous infusion of pemivibart for pre‑exposure prophylaxis against SARS‑CoV‑2 in certain immunocompromised adults and adolescents. This code bundles the infusion and post‑administration monitoring and matters nationally as clinicians and payers evaluate coverage pathways for targeted prophylactic therapies in high‑risk populations. Payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of what the code denotes, the clinical context for use in moderately to severely immunocompromised patients, and where the infusion is typically delivered. The publication outlines payer coverage considerations and common billing practices, highlights applicable benchmarking elements and coding guidance, and summarizes relevant policy updates affecting administration and reimbursement of pre‑exposure monoclonal antibody infusions. Data not available in the input is noted where applicable.
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Billing Code Overview
HCPCS Level II code M0224 describes the intravenous infusion of pemivibart for pre-exposure prophylaxis in specified adults and adolescents (12 years and older weighing at least 40 kg) with no known SARS‑CoV‑2 exposure who have moderate-to-severe immune compromise due to medical conditions or immunosuppressive therapies. The code includes the drug infusion and required post‑administration monitoring.
Service Type: Intravenous monoclonal antibody infusion for viral pre-exposure prophylaxis
Typical Site of Service: Outpatient infusion center, clinic infusion suite, or hospital outpatient department