← Back to list
Treatment of Coronavirus Disease 2019 (COVID-19)
Effective date
Not stated in the notice
Identified
Jun 20, 2026
Summary
Actemra (tocilizumab) and Olumiant (baricitinib) are considered medically necessary for treating COVID-19 in hospitalized adults who meet the listed oxygen, ventilation or ECMO criteria, and their cost is included within the hospital DRG. Veklury (remdesivir) is considered medically necessary for hospitalized adult and pediatric patients up to a maximum of 10 days, and for non-hospitalized patients with mild-to-moderate COVID-19 who are at high risk for progression, up to a maximum of 3 days. All other drugs, including those authorized under an Emergency Use Authorization, are considered investigational.
Get alerts when payers change rules like this one
We check Blue Cross & Blue Shield of Mississippi and other payers every day and email you when a change matches your specialty and state.
Get Blue Cross & Blue Shield of Mississippi alertsPolicy Monitoring is free. No card required.
What to do
Action · 10 steps
01REQUIREMENTS: Billing team: For hospitalized adults, Actemra, Olumiant and Veklury are included within the hospital DRG.
02Billing team: Bill remdesivir (HCPCS J0248, injection, remdesivir, 1 mg) for hospitalized adult and pediatric patients up to a maximum of 10 days, and for non-hospitalized patients up to a maximum of 3 days, only for the populations listed in the policy.
03Veklury for pediatric patients less than 28 days old and not weighing at least 3 kilograms is not medically necessary.
04Olumiant in combination with Veklury is listed as investigational.
05Other IL-6 pathway inhibitors (sarilumab, siltuximab) are listed as investigational.
06COVID-19 drugs paid for and dispersed by the Federal Government are not eligible for reimbursement.
07For Federal Employee Program members, all injections and other treatments for COVID-19, both FDA-approved and those authorized under an EUA, pay at regular medical benefits.
08For non-hospitalized treatment, the source criteria for high risk of progressing to severe COVID-19 include age 65 or older, obesity or overweight, pregnancy, chronic kidney disease, diabetes, immunosuppressive disease or treatment, cardiovascular disease or hypertension, chronic lung disease, sickle cell disease, neurodevelopmental disorders or medical complexity, medical-related technological dependence, and other conditions or factors that may increase risk.
09Those criteria apply to patients 12 years of age and older weighing at least 40 kg with positive direct SARS-CoV-2 testing within 10 days of symptom onset.
10Use the procedure codes listed in the policy's Medically Necessary Codes table for these administrations, and the diagnosis code U07.1 for COVID-19.
Codes mentioned
J0248U07.1M0224Q0224
Original notice
Treatment of Coronavirus Disease 2019 (COVID-19)
bcbsms.com · Always check the source before changing claims.