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HCPCS M0238 · Level II · code

M0238: Intravenous infusion, tocilizumab-anoh, HCPCS Level II code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: HCPCS Level II file: October 2026 (effective October 1, 2026); PFS relative value file: RVU26D, released August 26, 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); OPPS Addendum B: October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update) for the HCPCS Level II file and NCCI MUE tables and NCCI PTP edits and OPPS Addendum B; RVU27A with the CY2027 PFS final rule, effective January 1, 2027 for the PFS relative value file.

Key facts for M0238

Medicare payment
$450.50
OPPS rate, SI S
Coverage code
C
carrier judgment, so the Medicare contractor decides coverage
Facility outpatient MUE
1
MAI 2
OPPS status
SI S
Procedure or service, not discounted when multiple
NCCI PTP pairs
0
practitioner file
LCDs and articles
0 / 0

TL;DR

M0238 is a Level II code from the M section (medical services), in use since 2025: "Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose". Hospital outpatient departments are paid $450.50 for M0238 under status indicator S, APC 1506 (New Technology - Level 6 ($401 - $500)), minimum unadjusted copayment $0.00 (October 2026 Addendum B). CMS caps M0238 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. No current LCD or billing article lists M0238; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage). HCPCS record: BETOS O1G (immunizations/vaccinations); pricing indicator 54; type of service V (pneumococcal/flu vaccine). 10 other active codes open with "Intravenous infusion"; related codes: M0224, M0237, M0236, M0235.

M0238 descriptor and code status

The October 2026 HCPCS Level II file describes M0238 as “Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose”. It sits in the M section (medical services), listed with the other Other Level II codes.

HCPCS file attributes of M0238
FieldValue
Short descriptorIntrav inf, toci, second dos
Added to HCPCS2025-01-24
Last actionN (no maintenance), effective 2025-01-24
Coverage codeC: carrier judgment, so the Medicare contractor decides coverage
Pricing indicator54: vaccinations
BETOS categoryO1G: immunizations/vaccinations
Type of serviceV: pneumococcal/flu vaccine

Medicare payment for M0238

Hospital outpatient departments are paid $450.50 for M0238 under status indicator S, APC 1506 (New Technology - Level 6 ($401 - $500)), minimum unadjusted copayment $0.00 (October 2026 Addendum B). The amounts below are national figures from the October 2026 CMS files; the contractor applies the locality, rural or state adjustment and the beneficiary's cost sharing.

Physician fee schedule (RVU26D)

Status X: statutory exclusion: not a physician service under the fee schedule. Global period XXX (global surgery concept does not apply); PC/TC indicator 9 (professional/technical concept does not apply).

Hospital outpatient (OPPS Addendum B)

Status indicator S (Procedure or service, not discounted when multiple), APC 1506 (New Technology - Level 6 ($401 - $500)), national unadjusted payment $450.50 with a minimum unadjusted copayment of $0.00.

Medically Unlikely Edits for M0238

CMS caps M0238 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. The facility outpatient MUE is a date-of-service policy edit: units above the limit deny even when split across lines, and appeals rarely succeed.

MUE values for M0238 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction
Facility outpatient hospital12 Date of Service Edit: PolicyCode Descriptor / CPT Instruction

The MUE lookup for M0238 shows every setting next to any other code on the same claim.

NCCI edits and add-on rules

No active practitioner PTP pair lists M0238 in v323r0.

M0238 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Pair counts show exposure, not the answer for one claim. Check M0238 against a second code to see whether the pair bundles and whether a modifier can separate the services.

Medicare coverage policies for M0238

No current LCD or billing and coding article lists M0238. The HCPCS coverage code C means carrier judgment, so the Medicare contractor decides coverage, and any National Coverage Determination for the service still applies.

Denials to expect on M0238

CARC 50 · N115

the service is not reasonable and necessary for the diagnosis on the claim

CARC 151 · N362

units of M0238 exceed the facility outpatient MUE of 1 per date of service

CARC 4

the modifier reported is inconsistent with the code

CARC 16

the claim lacks information needed to adjudicate the line, such as an order, NPI or required modifier

Where QuickIntell fits for M0238 claims

QuickCode supports qualified coder review of units, modifiers and NCCI pairs for M0238 before the claim leaves, and QuickRCM carries claim readiness and the denial follow-up when an edit or coverage policy is missed.

See QuickCode for coder reviewSee QuickRCM for denial follow-upBook a meeting

Frequently asked questions: HCPCS M0238

What does HCPCS code M0238 describe?

"Intravenous infusion, tocilizumab-anoh, for hospitalized adult patients with covid-19 who are receiving systemic corticosteroids and require supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation (ecmo) only, includes infusion and post administration monitoring, second dose" (short descriptor "Intrav inf, toci, second dos"), in the M section (medical services). Added 2025-01-24.

Is M0238 a CPT code?

It is not. M0238 belongs to the M section (medical services) of HCPCS Level II, the CMS code set, not to AMA CPT.

What does Medicare pay for M0238?

Hospital outpatient departments are paid $450.50 for M0238 under status indicator S, APC 1506 (New Technology - Level 6 ($401 - $500)), minimum unadjusted copayment $0.00 (October 2026 Addendum B).

How many units of M0238 can be billed per day?

CMS caps M0238 at practitioner 1 (MAI 2, Code Descriptor / CPT Instruction); hospital outpatient 1 (MAI 2, Code Descriptor / CPT Instruction) units per day in the 2026 Q4 MUE tables. For the facility outpatient MUE (MAI 2), units above 1 deny for the whole day as a policy limit; denials arrive as CARC 151.

Does Medicare cover M0238?

No current LCD or billing article lists M0238; its HCPCS coverage code is C (carrier judgment, so the Medicare contractor decides coverage).

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

This page is an operational reference compiled from CMS publications: the HCPCS Level II file, the physician, DMEPOS and clinical laboratory fee schedules, OPPS and ASC addenda, NCCI MUE, PTP and add-on edit tables and the Medicare Coverage Database. Amounts are Medicare national figures before locality and state adjustment; Medicaid and commercial payers set their own. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.