Q0249 Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older)...
Q0249 - Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, 1 mg
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Medicare COVID-19 Fees
Labeler | Vaccine Procedure | Payment Allowance | Effective From | Effective To | Footnotes | My Fee |
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Genentech | Injection, tocilizumab, for hospitalized adults and pediatric patients (2 years of age and older) with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO) only, 1 mg | $6.57 | 2021-06-24 | TBD | [2] | (your fee) |
[2] Given the limited clinical situations allowed under the EUA, providers should only bill for tocilizumab on a 12x type of bill (TOB).
Learn more at: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies
Dosage | 1 MG |
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Payment Limit | $7.569 |
Vaccine AWP | 95% |
Vaccine Limit | $7.569 |
Clotting Factor | No |
Notes | See COVID-19 vaccine pricing webpage for payment effective dates |
These determinations shall be made by the local Medicare contractor processing the claim.
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