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.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour | Use for billing the infusion administration time for the initial hour of an IV infusion of pemivibart when payer requires a CPT infusion code in addition to the HCPCS drug code. |
| 96366 | Each additional hour (List separately in addition to code for primary service) | Use if the infusion or observation extends beyond the first hour and additional infusion time meets payer criteria.
| 36415 | Collection of venous blood by venipuncture | Use for pre-infusion laboratory monitoring or post-infusion testing as required.
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Use for pre-infusion evaluation and counseling when performed in the outpatient clinic prior to infusion.
| 96372 | Therapeutic, prophylactic, or diagnostic injection (subcutaneous or intramuscular) | Not typically used for Q0224 (intravenous infusion), but may be billed if an additional injectable medication administered IM/SC during the same encounter.
| 99499 | Unlisted evaluation and management service | Use only when no existing E/M code accurately describes a complex visit related to prophylactic infusion coordination (payer rules vary).