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Provider Notice Issued 10/21/2022

Date:   October 21, 2022

To:       Enrolled Hospitals:  Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers

Re:      COVID-19 Veklury (Remdesivir) Treatment for Pediatric Patients Effective April 25, 2022

_________________________________________________________________________________________________________

This notice announces coverage of the COVID-19 treatment Veklury (Remdesivir) for pediatric patients effective with dates of service beginning April 25, 2022. In accordance with Food and Drug Administration (FDA) guidance, the Department of Healthcare and Family Services (HFS) will cover this treatment for pediatric patients 28 days of age and older weighing at least 3 kilograms (about 7 pounds) with positive results of direct SARS-CoV-2 viral testing. This treatment is available for patients covered under Medicaid fee-for-service (FFS) and the HealthChoice Illinois (HCI) managed care plans.

Veklury (Remdesivir) is given in a hospital inpatient or outpatient setting as an infusion once a day for five days and may be extended up to 10 days. Per the FDA guidance, a child must be:

  • Hospitalized, or
  • Not hospitalized and have mild-to-moderate COVID-19 and is at high risk for progression to severe COVID-19, including hospitalization or death. 

 
Hospital Billing Guidance:

  • Providers must bill with HCPCS code: J0248 - Injection, Remdesivir, 1 mg
  • The approved unit of coverage is 1 mg
  • Providers must bill 11-digit NDCs and appropriate NDC units. The NDCs are:
    • Veklury 100 mg vial: 61958-2901-02
    • Remdesivir 100 mg vial: 61958-2901-01
    • Remdesivir 100 mg/20 mL vial: 61958-2902-01

 
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565.

 
Kelly Cunningham, Administrator
Division of Medical Programs



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JB Pritzker, Governor • Theresa Eagleson, Director




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