Summary & Overview
HCPCS Q0220: Tixagevimab and Cilgavimab Pre-Exposure Prophylaxis, 300 mg
HCPCS Level II code Q0220 represents a 300 mg dose of tixagevimab and cilgavimab administered for pre-exposure prophylaxis against SARS-CoV-2 in eligible individuals aged 12 and older (≥40 kg) who are either moderately to severely immunocompromised or cannot receive COVID-19 vaccination due to severe adverse reactions. This code matters nationally because it captures claims for a targeted monoclonal antibody prophylaxis used to protect high-risk populations who remain vulnerable despite vaccine-based strategies.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical use and service context, a summary of payer coverage considerations, and the typical sites where the service is delivered. The publication also highlights benchmark and policy-relevant elements such as coding specificity for prophylactic monoclonal antibody administration and implications for ambulatory infusion and outpatient administration workflows.
The content provides clinical context for coding and billing teams, revenue cycle stakeholders, and policy analysts seeking clarity on when to use HCPCS Level II code Q0220, how it aligns with patient eligibility criteria, and where services are commonly provided. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code Q0220 describes a 300 mg injection of tixagevimab and cilgavimab provided for pre-exposure prophylaxis against SARS-CoV-2. The service is intended for certain adults and pediatric individuals aged 12 years and older who weigh at least 40 kg and who either have moderate to severely compromised immune systems or for whom COVID-19 vaccination is not recommended due to a history of severe adverse reactions to a COVID-19 vaccine or vaccine component.
Service type: Monoclonal antibody prophylactic injection
Typical site of service: Outpatient infusion/administration setting, including ambulatory clinics, infusion centers, and other outpatient clinical locations where intramuscular or intravascular injections are performed.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a history of kidney transplant on chronic immunosuppressive therapy presents for pre-exposure prophylaxis against SARS-CoV-2. The patient is 12 years or older and weighs at least 40 kg. The clinical workflow includes pre-visit eligibility screening (confirmation of age, weight, immunocompromised status, and absence of known SARS-CoV-2 exposure), review of vaccination history and prior severe adverse reactions to COVID-19 vaccines or components, informed consent specific to monoclonal antibody prophylaxis, medication order entry for Q0220 (tixagevimab and cilgavimab, 300 mg), allergy check and medication reconciliation, administration in an outpatient infusion or clinic setting with appropriate personal protective equipment, and at least 30 minutes of post-injection observation for adverse events per facility protocol. Documentation includes indication, informed consent, lot numbers, route and site of injection, administering clinician and taxonomy, and any immediate adverse reactions. Billing uses HCPCS code Q0220 with relevant modifiers such as SH when applicable for second opinion or supervisory contexts as defined by payer policies.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
SH |