Chronic dialysis clinics

CPT codes 90380 and 90381 are reimbursable for billing Beyfortus

Effective for dates of service on or after July 17, 2023, CPT^® codes 90380 and 90381 are reimbursable when used for billing Beyfortus™(nirsevimab). Beyfortus is a respiratory syncytial virus (RSV) F protein-directed fusion inhibitor indicated for the prevention of RSV lower respiratory tract disease in neonates and infants born during or entering their first RSV season and children up to 24 months of age who remain vulnerable to servers RSV disease through their second RSV season. Nirsevimab is recommended by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC). A Treatment Authorization Request (TAR) justifying medical necessity is required for reimbursement.

Note: As of October 13, 2023, due to the current limited availability of Nirsevimab, CDC released a health advisory notice to provide options that would protect infants from RSV due to the limited availability. Providers may refer to this notice from the CDC for details of the interim recommendation.

Vaccines For Children (VFC): Beyfortus is a VFC benefit. The administration fee for the RSV monoclonal antibody is billed with either CPT code 90380 or 90381 and modifier SL.

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 (CDC)
• CDC recommends new vaccine to help protect babies against severe respiratory syncytial virus (RSV) illness after birth. Centers for Disease Control and Prevention; 2023