Emergency Use Authorization (EUA) Revoked for Evusheld

The Food and Drug Administration (FDA) announced on January 26, 2023, that Evusheld no longer has EAU.  

Please see the impacted codes and detail below.

Astrazeneca EUA Pre-Exposure Prophylaxis Treatment-Evusheld

 

Code

 

Code Description

MaineCare Effective Dates

Q0220

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), 300 mg

12/08/2021-01/25/23

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

12/08/2021-01/25/23

M0220

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

12/08/2021-01/25/23

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

12/08/2021-01/25/23

 

We will reprocess claims submitted and reimbursed for dates of service on or after January 25, 2023, and no provider action is needed.

If you have questions about Evusheld, please contact your Provider Relations Specialist.


 

Check out our new MaineCare logo! Learn more about this logo on the About Us page of our website.

MaineCare logo