Billing changes coming for COVID-19 treatment products

Since the development of COVID-19 treatment products, the U.S. government has provided these products at no cost to health care providers. Because of this, providers submitted claims to Blue Cross Blue Shield of Michigan or Blue Care Network only for the administration of the products.

As the remaining federal supply runs out, these products are transitioning to the commercial marketplace.After a product transitions, providers will need to purchase it and submit a claim to Blue Cross or BCN for both the product and the administration of the product. For Blue Cross commercial and BCN commercial members, out-of-pocket costs may apply for commercialized treatment products.

Notes:

• For Medicare Advantage members, we’re waiving all out-of-pocket costs for monoclonal antibody products and administration until the end of the year in which the public health emergency ends, according to the Centers for Medicare & Medicaid Services. Read the Dec. 17, 2021, provider alert for information about billing Medicare Advantage plans for monoclonal antibody products and administration.
• For information about billing for the vaccine product after the federal supply runs out, see this article.

Expected time frame for additional products to transition to commercial marketplace

According to the Administration for Strategic Preparedness & Response,** following is the expected time frame for these products to transition to the commercial marketplace:

• Evusheld, pre-exposure prophylaxis — early 2023
• Lagevrio, oral antiviral — first quarter 2023
• Paxlovid, oral antiviral — mid-2023

Additional information

For more information on COVID-19 vaccines, treatment, billing, etc., refer to our Coronavirus webpage. To access this page, log in to our provider portal (availity.com**) and follow these steps:

1. Click on Payer Spaces in the menu bar and then click on the BCBSM and BCN logo.
2. Click on the Resources tab.
3. Click on the Secure Provider Resources (Blue Cross and BCN) link.
4. Click on the Coronavirus information link under Easy Access.

You can also view these documents on our public coronavirus webpage.

Note: The U.S. Department of Health and Human Services is assisting providers who treat uninsured or underinsured patients with commercially purchased bebtelovimab by offering to replace the dose for free. HHS expects the supply for this initiative** to last through September 2023.

Availity is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal services.

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.