`M0224` Pemivibart infusion

What M0224 is

Intravenous infusion, 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, who either have moderate-to-severe immune compromise due to a medical condition or receipt of immunosuppressive medications or treatments, includes infusion and post administration monitoring

HCPCS Level II long description, CMS October 2026 file. See the M codes page for the full section.

Medicare payment for M0224 (CY2026)

This code has no Physician Fee Schedule rate: Statutory exclusion - not payable under the Physician Fee Schedule. It may be paid under a different fee schedule (clinical laboratory, DMEPOS, anesthesia) or not paid at all - check the relevant CMS schedule.

Medically Unlikely Edit (MUE)

Medicare caps M0224 at 1 unit per date of service for practitioner claims (MAI 2 - date of service edit (absolute): units above the MUE never pay), rationale: Code Descriptor / CPT Instruction. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with M0224? These codes are bundled into it

M0224 is a Column 1 code in 76 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`20560`	Ndl insj w/o njx 1 or 2 musc	1 - modifier may bypass	Check pair
`20561`	Ndl insj w/o njx 3+ musc	1 - modifier may bypass	Check pair
`36000`	Place needle in vein	1 - modifier may bypass	Check pair
`36410`	Vnpnxr 3yr/> phy/qhp dx/ther	1 - modifier may bypass	Check pair
`36425`	Venipuncture cutdown 1 yr/>	1 - modifier may bypass	Check pair
`36500`	Insertion of catheter vein	1 - modifier may bypass	Check pair
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`75893`	Venous sampling by catheter	1 - modifier may bypass	Check pair
`96360`	Hydration iv infusion init	1 - modifier may bypass	Check pair
`96365`	Ther/proph/diag iv inf init	0 - no modifier bypass	Check pair
`96372`	Ther/proph/diag inj sc/im	1 - modifier may bypass	Check pair
`96374`	Ther/proph/diag inj iv push	1 - modifier may bypass	Check pair
`96377`	Applicaton on-body injector	1 - modifier may bypass	Check pair
`96409`	Chemo iv push sngl drug	1 - modifier may bypass	Check pair
`96413`	Chemo iv infusion 1 hr	1 - modifier may bypass	Check pair
`96521`	Refill/maint portable pump	1 - modifier may bypass	Check pair
`96522`	Refill/maint pump/resvr syst	1 - modifier may bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`99202`	Office o/p new sf 15 min	1 - modifier may bypass	Check pair
`99203`	Office o/p new low 30 min	1 - modifier may bypass	Check pair
`99204`	Office o/p new mod 45 min	1 - modifier may bypass	Check pair
`99205`	Office o/p new hi 60 min	1 - modifier may bypass	Check pair
`99211`	Off/op est may x req phy/qhp	0 - no modifier bypass	Check pair
`99212`	Office o/p est sf 10 min	1 - modifier may bypass	Check pair
`99213`	Office o/p est low 20 min	1 - modifier may bypass	Check pair
`99214`	Office o/p est mod 30 min	1 - modifier may bypass	Check pair
`99215`	Office o/p est hi 40 min	1 - modifier may bypass	Check pair
`99221`	1st hosp ip/obs sf/low 40	1 - modifier may bypass	Check pair
`99222`	1st hosp ip/obs moderate 55	1 - modifier may bypass	Check pair

Showing 30 of 76 column 2 codes. Use the pair checker for any specific combination.

M0224 is bundled into these codes

M0224 appears as a Column 2 code in 1 active edits. Reported with one of these Column 1 codes on the same date of service, M0224 is the code that denies.

Column 1 code	Short description	Modifier indicator
`99291`	Critical care first hour	1	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.