Summary & Overview
HCPCS M0240: Casirivimab and Imdevimab Infusion or Injection with Monitoring
HCPCS Level II code M0240 represents administration of casirivimab and imdevimab via intravenous infusion or subcutaneous injection, inclusive of post-administration monitoring and any subsequent repeat doses. This code captures the clinical service of delivering monoclonal antibody therapy for eligible patients and is relevant nationally as monoclonal antibody treatments are used in acute care and outpatient infusion settings.
Key payers examined include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The analysis covers coverage policies, coding guidance, and payment benchmarks where available. Readers will find an overview of what M0240 denotes clinically, typical places of service, common billing considerations, and a summary of payer approaches and reimbursement patterns.
The publication provides practical benchmarking information, summaries of payer policy stances, and notes on billing practice implications tied to this administration code. It also outlines clinical context for the service line—therapeutic monoclonal antibody infusion/injection with monitoring—to help billing and policy teams align coding and documentation with payer requirements. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code M0240 describes administration of casirivimab and imdevimab by intravenous infusion or subcutaneous injection, and includes the administration procedure plus post-administration monitoring and subsequent repeat doses. The service is therapeutic monoclonal antibody administration for eligible patients requiring passive immunotherapy.
Service type: Therapeutic infusion/injection administration with monitoring
Typical site of service: Hospital outpatient departments, infusion centers, emergency departments, and other ambulatory infusion or injection settings
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with confirmed mild-to-moderate SARS-CoV-2 infection who is at high risk for progression to severe COVID-19 (for example, older age, immunocompromise, chronic cardiopulmonary disease, diabetes, or obesity). The patient presents to an outpatient infusion center, emergency department, or clinic within the therapeutic window for monoclonal antibody therapy. After eligibility confirmation, informed consent, and baseline vital signs and allergy screening, the clinician orders M0240 for intravenous infusion or subcutaneous injection of casirivimab and imdevimab. The infusion team prepares the product under sterile technique, administers the medication per protocol, and monitors the patient during the infusion and for the post-administration observation period for infusion-related reactions or hypersensitivity. Documentation includes indication, start and stop times, dose and route, premedications if given, continuous monitoring notes, and discharge instructions. Repeat dosing may occur per clinical protocol and is documented as subsequent administrations using the same HCPCS procedure descriptor.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or time is substantially greater than typical for the infusion due to complexity (document rationale). |