Q0247 sotrovimab 500 mg | HCPCS Reimbursement

HCPCS Level II code Q0247 denotes the administration of sotrovimab, 500 mg, an intravenous monoclonal antibody therapy. This code is used to bill for the drug product and its administration when sotrovimab is provided for eligible patients. Nationally, monoclonal antibody infusions represent a significant component of outpatient specialty therapeutics and billing for these agents has implications for payer coverage policies, site-of-care considerations, and provider reimbursement workflows.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical and billing context for Q0247, common service settings where sotrovimab is administered, and the types of benchmarks and policy topics typically associated with high-cost outpatient infusions. The publication outlines typical coding use, payer coverage patterns, and relevant administrative considerations such as site-of-service designation and service line placement.

This summary also identifies where data is available or absent and highlights areas readers can expect to explore further: reimbursement benchmarks, prior authorization practice, and payer-specific coding guidance. Data not available in the input will be clearly noted in the detailed sections.

Billing Code Overview

HCPCS Level II code Q0247 represents Injection, sotrovimab, 500 mg. This code denotes administration of the monoclonal antibody sotrovimab in a 500 mg dose vial for intravenous infusion.

Service Type: Intravenous monoclonal antibody infusion

Typical Site of Service: Outpatient infusion center, physician office, or hospital outpatient department

Clinical Context

A typical patient is an adult with laboratory-confirmed SARS-CoV-2 infection who is at high risk for progression to severe COVID-19 (for example, age ≥65, immunocompromised state, or chronic medical conditions such as diabetes or chronic kidney disease). The patient presents to an infusion center, emergency department observation unit, or outpatient clinic within the early symptomatic window (generally within 5–7 days of symptom onset) and is evaluated by a treating clinician. After eligibility assessment, informed consent, and screening for contraindications (allergy to monoclonal antibodies, current severe oxygen requirement for COVID-19), a single 500 mg dose of sotrovimab is prepared and administered as an intravenous infusion. Vital signs and infusion reaction precautions are documented; the patient is monitored during and for at least 1 hour after infusion for hypersensitivity or infusion-related reactions. Documentation includes indication, date/time of infusion, lot number, dose 500 mg, site of administration, and any immediate adverse events. Typical sites of service are hospital outpatient infusion centers, ambulatory infusion clinics, emergency departments, and skilled nursing facility medical suites capable of intravenous administration and monitoring.

Coding Specifications

Modifier	Description	When to Use
`23`	Unusual procedural service	When general anesthesia is administered for the infusion in an unusual circumstance

Taxonomy Code	Specialty	Notes
`2084P0800X`	Infectious Disease	Commonly evaluates eligibility and prescribes monoclonal antibody therapy
`363LF0000X`	Hematology/Oncology	Manages immunocompromised patients receiving monoclonal antibodies
`207Q00000X`	Family Medicine	Referring and treating outpatient clinicians who may order and supervise infusion
`163W00000X`	Internal Medicine	Primary treating physicians managing COVID-19 outpatient care
`3336C0002X`	Nurse Practitioner	Performs assessment, consent, and may supervise infusion nursing staff

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`U07.1`	COVID-19	Primary indication for monoclonal antibody treatment in patients with mild-to-moderate disease at high risk for progression
`Z20.822`	Contact with and (suspected) exposure to COVID-19	May be used when evaluating exposed high-risk patients for early therapy
`E11.9`	Type 2 diabetes mellitus without complications	Example high-risk comorbidity increasing risk for severe COVID-19 and supporting therapy eligibility
`N18.9`	Chronic kidney disease, unspecified	Immunocompromising comorbidity that elevates risk and supports treatment
`D89.9`	Disorder involving the immune mechanism, unspecified	Represents immunocompromised states that may justify monoclonal antibody therapy
`Z79.899`	Other long term (current) drug therapy	Indicates chronic immunosuppressive therapy when relevant to risk stratification

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Used when billing for the infusion administration time for a biologic monoclonal antibody like sotrovimab when infusion duration fits the time definition
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	Alternative administration code for non-chemotherapy monoclonal antibody infusions when applicable
`36415`	Collection of venous blood by venipuncture	Performed for baseline labs such as SARS-CoV-2 testing or pre-infusion labs if clinically indicated
`99024`	Postoperative follow-up visit, global period not applicable (used for routine follow-up)	Used by some clinicians for brief documented post-infusion follow-up visits or calls
`99070`	Supplies and materials provided by the physician (except drapes, sutures, etc.)	Used to report billable supplies directly related to infusion if payer allows

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Summary & Overview

HCPCS Q0247: Injection, sotrovimab, 500 mg