Summary & Overview
HCPCS Q0224: Pemivibart Injection for COVID-19 Pre-Exposure Prophylaxis, 4500 mg
HCPCS Level II code Q0224 designates the injectable monoclonal product pemivibart at a 4500 mg dose for COVID-19 pre-exposure prophylaxis in selected adolescents and adults who have no known SARS-CoV-2 exposure but are moderately to severely immunocompromised and unlikely to respond adequately to COVID-19 vaccination. Nationally, this code signals coverage and billing for a targeted preventive biologic intended to protect high-risk patients who cannot rely on vaccine-induced immunity.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise orientation to the clinical indication and service setting, an outline of common billing modifiers, and guidance on where payer coverage policies and reimbursement language typically align or diverge for pre-exposure prophylactic biologics. The publication also summarizes relevant policy updates, coding nuances for HCPCS Level II administration codes, and practical billing considerations such as service lines and typical sites of service.
This resource is written for a national audience of billing professionals, clinical administrators, and policy analysts seeking a clear, actionable summary of HCPCS Level II code Q0224, its clinical purpose, and the payer landscape relevant to administering pemivibart for pre-exposure prophylaxis.
Billing Code Overview
HCPCS Level II code Q0224 describes the administration of pemivibart injection for pre-exposure prophylaxis against COVID-19. The code represents a single-dose product of 4500 mg intended for use in certain adults and adolescents (12 years and older and weighing at least 40 kg) who have no known SARS-CoV-2 exposure and who either have moderate-to-severe immunocompromise from a medical condition or from immunosuppressive medications or treatments, and who are unlikely to mount an adequate immune response to COVID-19 vaccination.
Service type: Medication administration for pre-exposure prophylaxis.
Typical site of service: Outpatient clinic, infusion center, or other ambulatory care setting where injectable biologic prophylaxis is administered.
Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.
Clinical & Coding Specifications
Clinical Context
A 58-year-old patient with a solid organ transplant is followed in a hospital-based infectious disease clinic. The patient is at least 12 years old and weighs more than 40 kg, has completed COVID-19 vaccination but is judged unlikely to mount an adequate vaccine response due to ongoing immunosuppressive therapy. The clinician orders a single-dose intravenous administration of Q0224 (pemivibart 4500 mg) for pre-exposure prophylaxis against SARS-CoV-2. The clinical workflow includes verification of eligibility (age, weight, immunocompromised status), informed consent, review of allergies, baseline vital signs, venous access placement, pharmacy compounding and verification of the 4500 mg dose, administration in an outpatient infusion center or hospital infusion suite, post-infusion monitoring for infusion reactions for the recommended observation period, documentation of lot number and expiration, and billing using the HCPCS Level II code Q0224 with appropriate modifiers for place of service or payer requirements. Typical sites of service are outpatient hospital infusion centers, ambulatory infusion suites, and specialty clinics for immunocompromised patients. The typical patient scenario involves scheduled, one-time or periodic prophylactic infusion for adults or adolescents (≥12 years, ≥40 kg) with moderate-to-severe immune compromise from a medical condition or immunosuppressive treatment, and no known recent SARS-CoV-2 exposure at time of administration.
Coding Specifications
| Modifier | Description | When to Use |
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