Beyfortus (Nirsevimab) Administration CPT Codes
Starting July 17th, 2023, it has now been possible to reimburse Beyfortus CPT Code 90380 or 90381 when used together with Beyfortus (TM), also known as Nirsevimab, against claims for Respiratory Syncytial Viral (RSV), a protein directed toward fusion that reduces risk for infants and newborns in their first or upcoming RSV season, as well as children aged up to 24 months who are at increased risk of severe RSV disease in their second RSV season. ACIP and the Centers for Disease Control and Prevention (CDC) recommend Nirsevimab as an effective treatment against RSV-lower respiratory tract diseases caused by respiratory synovial virus outbreaks.
The American Medical Association (AMA) has approved new Current Procedural Terminology (CPT) codes to cover administration of Nirsevimab (Beyfortus), an anti-monclonal that helps protect children and infants against respiratory syncytial virus illness (RSV). Here is a complete guide for coding Nirsevimab as well as palivizumab (Synagis), another monoclonal antibody recommended for infants aged 24 months.
Nirsevimab (Beyfortus) CPT Codes and Dosing Guidelines:
CPT Editorial Panel of the AMA approved CPT codes 90381 and 90380 on May 24 and they became official as effective June 30.
Nirsevimab (Beyfortus) Dosing Guidelines:
|
Age Group |
Weight/Condition | Dosage Details |
CPT Code |
| Infants Younger than 8 Months | Less than 5 kilograms (kg) | One 0.5 milliliter (mL) dose | 90380 |
| Infants Younger than 8 Months | 5 kg or more | One 1 mL dose | 90381 |
| Infants and Children 8-19 Months | Those at increased risk of severe RSV disease entering their second RSV season | One 200 milligram (mg) dose, administered through two separate 1 mL intramuscular (IM) injections | 90381 |
Example: An infant weighing 4 kg at the start of their first RSV season would receive one dose of Nirsevimab (0.5 milliliters). This dose offers additional protection from RSV infection; its CPT code is 90380.
Nirsevimab (Beyfortus) CPT Codes Guidelines:
Provide the following codes of products according to dose:
| CPT Code |
Description |
Fee 2024 |
| 90380 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use. | $0.00 |
| 90381 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use. | $0.00 |
Example: At seven months old and 6 kilograms, an infant receiving one milliliter should be reported using CPT codes 90381 from Vaccines for Children or any managed-care organization guidelines as determined by your state guidelines or managed care organization guidelines; certain states also require adding an “SL modifier” in order to report these products as approved by government authorities.
Nirsevimab (Beyfortus) Administration Codes:
On October 6, the AMA released two new CPT codes for the administration of nirsevimab:
| CPT Code |
Description |
Fee 2024 |
| 96380 | Used to report the counseling and administration of nirsevimab. | $22.64 |
| 96381 | Used to report the administration of nirsevimab on a different date than the counseling by a physician or qualified health care professional (QHP). |
$19.64 |
Example: If a doctor counsels and administers Nirsevimab on the same day, record this date using code 96380; for all other dates, report code 96381. For Claim dates ranging between October 6 and after should not use code 96372 (subcutaneous injection of an ingredient or drug subcutaneously or intramuscularly) when administering Nirsevimab; instead, use code 96372 as this pertains to palivizumab administration. Immunization administration codes 90460 and 90471 only cover toxoid vaccine products; therefore, do not declare Nirsevimab and Palivizumab administrations as immunization administration codes 90486 administrations in conjunction.
Nirsevimab (Beyfortus) Diagnosis Codes:
Nirsevimab administration cannot be included under ICD-10-CM code Z23 (Encounter for Vaccination). Instead, using an appropriate diagnosis code is key to billing, claim payment, and quality indicators.
| ICD Code |
Description |
| Z29.11 | Encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV). |
Example: In billing to prescribe Nirsevimab prophylactically against RSV, use Z29.11 to indicate this prophylaxis therapy. This guideline ensures accurate billing and coding for administering Nirsevimab, as well as the collection of vital information and quality metrics. For further details as well as any specific rules specific to any state health department’s instructions.
Understanding Palivizumab (Synagis) for RSV Prophylaxis
Palivizumab (Synagis) Synagis is an antibody monoclonal prescribed to high-risk children and infants aged 24 months or less who are between 24 and 24 months old to protect them against severe respiratory syncytial virus (RSV) illnesses. For optimal protection during RSV season, a 15 mg/kg injection should be given intramuscularly before RSV season commences, followed by 4 doses every month during its progression.
CPT Codes Guidelines:
If you are reporting palivizumab’s administration, use CPT 90378 for accurate reporting. Based on payer policy, accurate wastage reporting may also be possible using either the JW modifier for reporting wastage or by dividing the total amount injected by the total milligrams contained within the vial (50 mg) to find an accurate volumetric measurement from CPT 90378.
| CPT Code |
Description |
Fee 2024 |
| 90378 | Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each | $0.00 |
Reporting Examples of Nirsevimab and Palivizumab Administration
Nirsevimab Administration:
Scenario: An infant weighing 4.8 kilograms at 2 months old will soon receive an injection of Nirsevimab 0.5 mg. A registered nurse (RN) provided counseling and responded to the mother’s queries during their well-child visit two weeks prior, after which they obtained the mother’s consent for the injection.
Coding Tips: An RN who provides additional counseling and administers Nirsevimab does not need to report an E/M code, such as 99211. Counselling does not equate to managing conditions; its use for coding purposes alone does not indicate this fact.
CPT Codes:
| CPT Code |
Description |
Fee 2024 |
| 90380 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular (IM) use. | $22.64 |
| 96381 | Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular (IM) injection. | $19.64 |
Palivizumab Administration:
Scenario: An established patient, four months and 6 kg, with severe immune impairment, visits the well-child clinic to discuss RSV season and monoclonal antibody treatments to protect from it. Having listened to her mom’s concerns, she consents to proactively implement preventative therapy. Given the lack of Nirsevimab, the doctor will prescribe palivizumab and administer an initial 90 mg injection.
Coding Tips: When reporting two units of 90378 using the JW modifier, follow your payer’s policy, or submit 1.8 units as waste product (90 mg/50 mg equals 1.8 units). With these guidelines and examples in hand, healthcare professionals can ensure accurate billing procedures when billing RSV monoclonal antibodies, guaranteeing payment and records.
CPT Codes:
| CPT Code |
Description |
Fee 2024 |
| 99392 | Periodic comprehensive preventive medicine reevaluation and management of an established patient; early childhood (age 1 through 4 years) |
$104.19 |
| 90378 | Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular (IM) use, 50 mg, each | $0.00 |
| 96372 | Therapeutic, prophylactic or diagnostic injection (specify substance or drug); subcutaneous or IM | $14.31 |
Resources:
- CCS Numbered Letter 13-0914
- Palivizumab for Immunoprophylaxis of Respiratory Syncytial Virus Infection during 2022–2023
- Redbook Online. ACIP and AAP Recommendations for Nirsevimab. American Academy of Pediatrics
- Proposed clinical considerations for maternal RSVPreF vaccine and nirsevimab (Centers for Disease Control and Prevention) (2023)
- CDC recommends new vaccine to help protect babies against severe respiratory syncytial virus (RSV) illness after birth. Centers for Disease Control and Prevention; 2023
Frequently Asked Questions (FAQ):
What is CPT code 90380 and 90381?
CPT codes 90380 and 90381 are commonly utilized for immune globulin therapy, more specifically:
CPT Code 90380: This code enables the intramuscular injection of respiratory syncytial virus immune globulin (RSV-IgIM). RSV-IgIM acts as an immunoglobulin to protect high-risk infants from severe RSV infections.
CPT Code 90381: This code describes an intravenous infusion of RSV-IgIV. This treatment, akin to 90380, targets high-risk infants through this specific route of administration.
What is the CPT code for Beyfortus 100 mg/mL intramuscular syringe?
Under CPT’s RSV immune globulins administered subcutaneously coding scheme, Beyfortus (nirsevimab-alip), administered intramuscularly using an injection syringe with 100 mg/mL, has the code 90380. Beyfortus can help protect children and infants against RSV infection with its prevention capabilities.
What is the HCPC code for Beyfortus?
The HCPCS J3490 generic drug code category includes Beyfortus. Since an exact HCPCS code may not have been assigned yet, J3490 is used to classify it for billing purposes until a better HCPCS code is available.
What is CPT code 90378 used for?
CPT 90378 is used for palivizumab (Synagis), an injection administered to high-risk children to protect them from serious respiratory syncytialvirus infection (RSV). Preemptive administration of palivizumab injections often shields those born prematurely or with lung or cardiac ailments from RSV infection. Its main role is prevention.
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