M0243 Insurance Policy Changes

HCPCS M0243 is officially defined as "Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring." HCPCS M0243 is referenced in 3 tracked payer policy changes from Kansas Medicaid (KanCare), Michigan Medicaid - MDHHS, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS M0243 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.