go back

South Dakota rates for HCPCS M0221

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), includes injection and post administration monitoring in the home or residence; this includes a beneficiary's home that has been made provider-based to the hospital during the COVID-19 public health emergency

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$250.50 / $250.50 / $250.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.50 / $250.50 / $313.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$307.64 / $307.64 / $446.94
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.45 / $375.54 / $507.37