Provider Central

This article is for all providers caring for our members

Blue Cross Blue Shield of Massachusetts follows federal and state-mandated requirements for COVID-19 treatment coverage. This article clarifies when vaccines and pharmaceutical treatments for COVID-19 are covered.

Vaccines

For our commercial products (managed care HMO and POS, PPO, and Indemnity), we will accept the following CPT codes for the Pfizer and Moderna vaccines.

For Medicare plans, please do not bill with these codes. Instead, submit claims for administration of the COVID-19 vaccine to the CMS Medicare Administrative Contractor (MAC) for payment.

We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. For more details please visit fepblue.org. This is in place for the duration of the state of emergency.

FDA-approved pharmaceutical treatment for COVID-19 infection

Blue Cross Blue Shield of Massachusetts covers all FDA-approved drugs for COVID-19 with no cost share to our members throughout the duration of the public health emergency. This applies both to our commercial and Medicare plans.

Remdesivir (Veklury) has received FDA approval for adults and pediatric patients over the age of 12 in an inpatient hospital setting.

Emergency utilization approval (EUA) treatments for COVID-19 infection

The following therapeutic agents have received EUA and will be covered under our commercial and Medicare plans:

*Please bill bamlanivimab with the following codes for our commercial plans:

For Medicare plans, please do not bill with these codes. Instead, submit claims for administration of bamlanivimab to the CMS MAC for payment.

We are following guidelines from the Blue Cross Blue Shield Association regarding coverage for Federal Employee Program members. For more details please visit fepblue.org. This is in place for the duration of the state of emergency.

As codes are developed for other therapeutic agents that have EUA approval, we will communicate the details when they become available. Examples: caririvima/imdemvimab and baracitinib.

Drugs under investigation for COVID-19 infection

Drugs that are covered

Several drugs are under investigation as potential treatments for COVID-19 that have shown early benefit in clinical trials. Blue Cross Blue Shield of Massachusetts covers the following drugs when used outside a clinical trial for patients who are in an inpatient hospital setting and require treatment beyond respiratory support, at the discretion of their treating provider:

• Antiviral therapy (such as hydroxychloroquine; the original hydroxychloroquine policy still applies)
• Immunomodulators (such as dexamethasone)

Please note that standard inpatient payment policy rules apply.

Drugs that are not covered

Blue Cross Blue Shield of Massachusetts does not cover drugs under investigation through clinical trials that have not demonstrated improvement in patient outcomes in early studies or are not recommended for use outside of the clinical trial setting by the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), or Department of Public Health (DPH) guidelines.

The following drugs are not covered outside of the clinical trial setting:

• Blood-derived products (such as SARS-CoV-2 immunoglobulins, mesenchymal stem cells)
• Antiviral therapies or immunomodulators without published supporting evidence (such as lopinavir/ritonavir, other HIV protease inhibitors)
• Other therapies currently under investigation without published supporting evidence

Resources

• NIH guidance regarding treatments
• CMS press release on New Hospital Procedure Codes for Therapeutics in Response to the COVID-19 Public Health Emergency 
• FEP COVID-19 Coronavirus Resource Center 

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