22-768m Give Priority to Members With COVID-19 Symptoms or Who Test Positive
Date: 09/14/22
Assess members for COVID-19 therapeutics eligibility including monoclonal antibody infusion treatments
Members with symptoms of COVID-19 or who test positive for COVID-19 are considered a priority when scheduling appointments. To be effective, offer urgent appointments so members can be evaluated for the right treatment options.
If the member is clinically eligible, outpatient COVID-19 therapeutics should be offered immediately. They are only effective if given within five to seven days after symptoms start. Note that all eligible patients should be offered pre-exposure prophylaxis, if they qualify under the emergency use authorization (EUA).1
Monoclonal antibody infusion treatment is a covered benefit
After June 1, 2021, normal cost shares and prior authorization guidelines, if any, apply. The infusion administration is not carved out of the managed Medi-Cal program. The medication and infusion’s administration fee are billable to the appropriate payor based on the Plan’s existing division of financial responsibility with the capitated physician group/IPA. Medication that is available free from the federal government is not reimbursable.
- For a list of approved HCPCS codes, visit the online COVID-19 Updates and Alerts for Providers> COVID-19 General Information > COVID-19 Testing and Screening, Billing and Treatment Information > Does Health Net cover monoclonal antibody infusion treatment for COVID-19?
- Download a list of infusion sites that offer monoclonal antibody infusion treatments.
Additional information
If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.
1 Visit the Department of Health Care Services All Plan Letter (APL) 22-009, dated June 13, 2022.
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.