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MedicaidCoverageMedium impact

Revised policy for therapies for COVID-19

Washington Apple Health·WA · Infectious Disease, Internal Medicine, Family Medicine +1 more·Medical Policy
Effective date
Jan 24, 2022
We identified it
Jun 20, 2026
Days to comply

Summary

Washington State Medicaid (HCA) has revoked coverage for multiple COVID-19 monoclonal antibody therapy codes due to FDA emergency use authorization withdrawals. Coverage stopped retroactively from January 24, 2022 and April 5, 2022 for different code sets.

Action Required

Action needed
Immediately: Billing team must stop billing codes M0240, M0241, M0243, M0244, M0245, M0246, Q0240, Q0243, Q0244, Q0245, M0247, M0248, Q0247 for Washington State Medicaid patients. Review and rebill any claims from January 24, 2022 forward that used these codes as they are no longer covered. Update billing system to block these codes for HCA Medicaid claims.

Affected Billing Codes

M0240
M0241
M0243
M0244
M0245
M0246
Q0240
Q0243
Q0244
Q0245
M0247
M0248
Q0247