Summary & Overview
HCPCS Q0221: Tixagevimab and Cilgavimab Injection, Pre-Exposure Prophylaxis 600 mg
HCPCS Level II code Q0221 denotes the injection of tixagevimab and cilgavimab, 600 mg, used for pre-exposure prophylaxis against SARS-CoV-2 in selected patients aged 12 years and older (≥40 kg) with no known exposure. This code is clinically important as it identifies use of monoclonal antibody prophylaxis for patients who are immunocompromised or cannot receive COVID-19 vaccines due to prior severe adverse reactions. Nationally, accurate use of this HCPCS code supports appropriate coverage determinations, continuity of care for high-risk patients, and tracking of prophylactic monoclonal antibody utilization.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will gain a concise understanding of the code’s clinical purpose, common sites where the service is delivered, and the payer landscape relevant to coverage and claims processing. The publication also summarizes benchmarks and policy updates affecting reimbursement and coding practice, and provides clinical context about patient eligibility and the service modality. Where specific payer policies or benchmark data are not supplied, the report notes that data are not available in the input. This summary is intended for coding professionals, revenue cycle staff, and clinical leaders managing provision and billing of pre-exposure monoclonal antibody prophylaxis.
Billing Code Overview
HCPCS Level II code Q0221 describes the administration of tixagevimab and cilgavimab as a single 600 mg dose for pre-exposure prophylaxis against SARS-CoV-2. The indication covers certain adults and pediatric individuals 12 years of age and older weighing at least 40 kg who have no known SARS-CoV-2 exposure and either have moderate to severely compromised immune systems or for whom COVID-19 vaccination is not recommended due to a history of severe adverse reaction to a COVID-19 vaccine or vaccine component.
Service Type: Medication administration for pre-exposure prophylaxis
Typical Site of Service: Outpatient clinic, infusion center, or other ambulatory care setting where monoclonal antibody injections are administered
Clinical & Coding Specifications
Clinical Context
A 63-year-old female with a history of rheumatoid arthritis on rituximab therapy and chronic lymphocytic leukemia presents to an infusion clinic for pre-exposure prophylaxis against SARS-CoV-2. She is not currently infected and has had a documented severe immediate hypersensitivity reaction to a prior mRNA COVID-19 vaccine, making vaccination not recommended for her. After verification of indication, informed consent, and pre-administration screening (allergy review, vital signs, and medication reconciliation), the clinic schedules a single intramuscular administration of Q0221 (tixagevimab and cilgavimab, 600 mg) per EUA/label guidance. The infusion clinic or outpatient injection suite documents patient identity, clinical indication, lot numbers, and injection site, administers the medication intramuscularly, observes the patient for the recommended post-administration period for adverse reactions, and submits the claim with the appropriate modifier SH when applicable for partial payment or split billing scenarios. Typical sites of service include outpatient infusion centers, ambulatory clinics, and physician office-based injection suites serving adults and pediatric individuals aged 12 years and older weighing at least 40 kg who meet the indication for pre-exposure prophylaxis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
SH | Billing for shared services |