Convalescent Plasma: New HCPCS Code for Outpatients
Published date: February 15, 2022
On December 28, 2021, the FDA revised the emergency use authorization (EUA) for COVID-19 convalescent plasma with high titers of anti-SARS-CoV-2 antibodies. It is now authorized in both the inpatient and outpatient setting for patient with immunosuppressive disease or getting immunosuppressive treatment.
On February 10, 2022, CMS issued a new HCPCS code, C9507-Fresh frozen plasma, high titer COVID-19 convalescent, frozen within 8 hours of collection, each unit, billable for dates of service on or after December 28, 2021. The CMS payment rate for C9507 is $750.50.
Pharmacies may not purchase or dispense the product but may be involved in reviewing the patient’s record and profiling the convalescent plasma to provide a comprehensive COVD-19 treatment record in the EHR. Although convalescent plasma is not yet approved by the FDA, it can be provided either under the current EUA or an investigational new drug (IND) application. The product is regulated as a biologic under the Center for Biologics Evaluation and Research (CBER) division of the Food and Drug Administration (FDA).
1. Pharmacy Departments and Blood Banks should review ordering and dispensing of convalescent plasma to ensure that patients meet all criteria authorized in the EUA and that the product is handled and billed as a biologic with HCPCS code C9507 when administered to outpatients.
2. Revenue Integrity should review all patient records for outpatients who received convalescent plasma on or after December 28, 2021 and consider re-billing claims with the new HCPCS code.
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