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See a sample rate comparisonHCPCS M0224 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
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
| Key Fact | Detail |
|---|---|
| Service Type | Miscellaneous Medical Services |
| Complexity Level | Moderate |
| Medicaid Fee Schedule | View Medicaid rates for M0224 |
National average reimbursement for HCPCS M0224 by major payers:
$561.98
$726.11
$449.09
$503.54
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HCPCS M0224
5 of 25 sample ratesHigher to lower in this preview
Hospital Authority Of Jefferson County And The City Of Louisville, Jefferson Hospital
Hospital Authority Of Jefferson County And The City Of Louisville
$1,100.96Published rateMichael Guillette
Aztec Urgent Care LLC
$819.67Published rateThe Baxley And Appling County Hospital Authority, Appling Healthcare System
Appling Hospital
$632.52Published rateEmanuel County Hospital Authority, Emanuel Medical Center
$506.01Published rateMichael Koch
Pathology Lab Of Georgia LLC
$450.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalHCPCS M0224 vs. Other Miscellaneous Medical Services Codes
The HCPCS M0224 code is part of the Miscellaneous Medical Services services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS M0224 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| M0224-HCPCS | Moderate | 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS M0224. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the M0224 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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