Q0222 - HCPCS Code for Injection, bebtelovimab, 175 mg

HCPCS Code Details - Q0222
HCPCS Level II Code Miscellaneous Services (Temporary Codes) Search
HCPCS Code	`Q0222`
Description	Long description: Injection, bebtelovimab, 175 mg Short description: Bebtelovimab 175 mg
HCPCS Modifier¹
HCPCS Pricing indicator	`54` - Vaccinations
Multiple pricing indicator	`A` - Not applicable as HCPCS priced under one methodology
Coverage code	`C` - Carrier judgment
BETOS² code	`O1G` - Immunizations/Vaccinations
HCPCS Action code	`N` - No maintenance for this code
Type of service	`V` - Pneumococcal/flu vaccine
Effective date	Effective Feb 11, 2022
Date added	Added Feb 11, 2022
HCPCS Coding Procedures

ASP Drug pricing - Q0222

Code Dosage	Payment Limit	Vaccine AWP %	Vaccine Limit	Infusion AWP %	DME infusion limit	Blood AWP %	Blood limit
175 MG	2394	0%	-	-	-	-	-
175 MG	2394	-	-	-	-	-	-
175 MG	2394	-	-	-	-	-	-

HCPCS Q0221 · Injection, tixagevimab and cilgavimab, for the pre-exposure prophylaxis only, for certain adults and pediatric individuals (12 years of age and older weighing at least 40kg) with no known sars-cov-2 exposure, who either have moderate to severely compromised immune systems or for whom vaccination with any available covid-19 vaccine is not recommended due to a history of severe adverse reaction to a covid-19 vaccine(s) and/or covid-19 vaccine component(s), 600 mg
HCPCS Q0224 · Injection, pemivibart, for the pre-exposure prophylaxis only, for certain adults and adolescents (12 years of age and older weighing at least 40 kg) with no known sars-cov-2 exposure, and who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, and are unlikely to mount an adequate immune response to covid-19 vaccination, 4500 mg

¹ Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

² BETOS stands for “Berenson-Eggers Type Of Service”