CMS creates new HCPCS code for antiviral medication

CMS recently created a new Healthcare Common Procedure Coding System (HCPCS) code, J0248, for VEKLURY™ (remdesivir), an antiviral medication that is used to treat COVID-19.

The FDA approved the medication after its effectiveness in treating COVID-19 was studied in various clinical trials. The HCPCS code, which took effect December 23, 2021, is now available for all payers to use when remdesivir is provided in outpatient settings.

The descriptors for remdesivir are as follows:

• Long descriptor: Injection, remdesivir, 1 mg
• Short descriptor: Inj, remdesivir, 1 mg

Since there is no national coverage determination for the medication, the Medicare Administrative Contractors (MAC) will determine Medicare coverage for the new code based on its medical necessity. Your MAC will provide additional information on coverage and claims processing.

Editor’s note: Access more NAHRI resources on COVID-19 coding and billing codes here.