MedicaidBilling CodesMedium impact
MAB2021032201
Pennsylvania Medicaid (DHS)·PA · Family Medicine, General Practice, Internal Medicine +2 more·Provider Bulletin
Effective date
Feb 9, 2021
We identified it
Jun 20, 2026
Summary
Pennsylvania Medical Assistance (Medicaid) added CPT code M0245 for IV infusion of bamlanivimab and etesevimab monoclonal antibody therapy for COVID-19 treatment, reimbursing at $247.68 per administration. This applies to physicians, outpatient hospital clinics, and independent medical surgical clinics in the fee-for-service system.
Action Required
Immediately: Billing team must add CPT code M0245 to billing system for IV infusion of bamlanivimab and etesevimab COVID-19 monoclonal antibody therapy, set reimbursement rate at $247.68, and configure as once-per-day limit. Do not bill for the monoclonal antibody products received at no cost from federal government - only bill for administration services.