Veklury (Remdesivir)
Has anyone read up on this recently? From what I am reading is that effective Oct 22, this is for Inpatient ONLY use. Has anyone seen anything different? Also, has anyone found a JCode for this?
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Has anyone read up on this recently? From what I am reading is that effective Oct 22, this is for Inpatient ONLY use. Has anyone seen anything different? Also, has anyone found a JCode for this?
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As the FDA just approved, this can be billed on hospital outpatient claims with C9399 per the Medicare Claims Processing Manual, Chapter 17, Section 90.3. That said, we are still only using this drug for inpatients.
Based on what FDA has published about the EUA, this is limited to "hospitalized" patients. CMS has more specific information regarding their coverage for MEdicare patients in the latest IFC (https://www.cms.gov/files/document/covid-vax-ifc-4.pdf). They note that this remdesivir is approved only for inpatient administration. It lists the PCS codes that will trigger the new technology COVID add on payment as well as how CMS will calculate the NTAP. CMS notes that so far there is no EUA for treating patients in the OP setting but they have determined that if/when this occurs, there will be separate payment for the therapy when part of the OBS C-APC.
I would be interested to see if anyone is giving this treatment in the outpatient setting and how they are billing for it. Our facility is preparing to give this treatment in the outpatient setting.
CMS provides information regarding OP administration in the FAQs. Updated 3/5/21:
"CMS expects that the vast majority of infusions of Remdesivir will take place in inpatient settings, consistent with the current drug labeling. These inpatient infusions could occur in traditional inpatient settings, or in alternate care sites that furnish inpatient care and bill under the Inpatient Prospective Payment System. Additional information regarding hospital flexibilities in place during the COVID-19 Public Health Emergency is available here:https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers. "
"Questions about coverage of Remdesivir when a patient is not an inpatient, such as treatment occurring in outpatient hospital departments or in physician offices, should be directed to the Medicare Administrative Contractor that processes a provider or supplier’s claims. This includes questions about off label uses of Remdesivir, such as its use in outpatient acute care settings."