The Centers for Medicare & Medicaid Services (CMS) issued a new Healthcare Common Procedure Coding System (HCPCS) code for the antiviral medication VEKLURYTM (remdesivir) when administered in the outpatient setting in a Jan. 7 announcement. The new code is in response to the recent statement from the National Institutes of Health COVID-19 Treatment guidelines regarding therapies for the Omicron variant of COVID-19.
The CMS noted that because Medicare Administrative Contractors (MACs) determine Medicare coverage when there is no national coverage determination, including in cases when providers use Food and Drug Administration (FDA)-approved drugs for indications other than what is on the approved label, they will determine Medicare coverage for HCPCS code J0248 for VEKLURY™ (remdesivir) administered in an outpatient setting. The announcement concluded that MACs would share coverage and claims processing information for J0248.