MedicaidBilling CodesMedium impact
MAB2021032501
Pennsylvania Medicaid (DHS)·PA · Infectious Disease, Internal Medicine, Family Medicine +1 more·Provider Bulletin
Effective date
Nov 9, 2020
We identified it
Jun 20, 2026
Summary
Pennsylvania Medicaid has added two new CPT codes (M0239 and M0243) to their fee schedule for administration of COVID-19 monoclonal antibody therapies, with reimbursement at $247.68 per infusion. These codes are for bamlanivimab and casirivimab/imdevimab administration respectively, limited to once per day.
Action Required
Immediately: Billing team must add CPT codes M0239 (bamlanivimab infusion) and M0243 (casirivimab/imdevimab infusion) to billing system for Pennsylvania Medicaid claims with reimbursement rate of $247.68. Set frequency limit to once per day for both codes. Do not bill for the monoclonal antibody products themselves if received at no cost from federal government - only bill for administration services.