Infusion services remain a vital component of medical treatment for patients across the nation, each area containing its own complexities that create challenges for coders and compliance professionals alike. In July 2023, the FDA gave the green light to Beyfortus™ (nirsevimab-alip) for infants under eight months old encountering their first respiratory syncytial virus (RSV) season and certain high-risk children aged 8–19 months entering their second RSV season. While nirsevimab acts as a preventative measure against illness, it is crucial to understand that the FDA categorizes it as a drug rather than a conventional vaccine. This classification has triggered uncertainty among medical coders regarding the appropriate CPT® code for reporting administration and how to account for counseling efforts, particularly in pediatric settings. Let’s analyze more of the specific details for accurate understanding and successful outcomes throughout 2024 and beyond.
Initially, providers were guided to use CPT code 96372 for administering nirsevimab. However, in September 2023, the CPT Editorial Panel authorized immunization administration codes 96380 and 96381, effective from October 6, 2023. Understand that these codes are not yet included in the 2024 CPT Manual but are slated for inclusion in the 2025 edition, positioned after code 96377. This update streamlines the coding process, ensuring accurate reporting of nirsevimab administrations.
Unlike traditional vaccines, the administration of nirsevimab is not reported with the ICD-10-CM code Z23 (Encounter for immunization). Coders should understand that this diagnosis code is specific to immunization related to vaccines.
Instead, coders should refer to Z29.11 Encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV). Utilizing the correct diagnosis code is pivotal for billing accuracy, claims processing, and data integrity. Moreover, when administering nirsevimab to patients with high-risk conditions, it’s essential to append code Z29.11 alongside the relevant ICD-10-CM code corresponding to each patient’s specific high-risk condition.
| Code | Description |
| 90380 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use |
| 90381 | Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use |
www.ama-assn.org/system/files/vaccine-long-descriptors.pdf
When should the above codes be reported? Assign either CPT code 90380 or 90381 on all claims for Beyfortus (nirsevimab-alip). Understand that these codes are specific to passive immunization for pediatric seasonal dose for RSVb and are differentiated by dose description of 0.5-mL dose and 1-mL. For clarity, report as one unit of 90380 when a 0.5-mL dose is administered. Report as one unit of 90381 when a 1-mL dose is administered and submit two units of 90381 when a 2-mL dose is administered.
It’s worth noting that the monoclonal antibody palivizumab carries the product code 90378 and is not to be reported with administration codes 96380 or 96381. The guidance provided by the AMA instructs healthcare providers to utilize the new CPT codes specifically designated for the administration of respiratory syncytial virus monoclonal antibody seasonal doses, outlined as 90380 and 90381. For a more comprehensive discussion on coding pertaining to the administration of vaccines or toxoids, refer to Chapter 19.
These are not all the tips necessary for successful infusion and injection therapy coding. Secure your copy of the 2024 Coding Essentials for Infusion & Injection Therapy Services eBook by March 29, 2024, and enjoy a $50 discount!
To take advantage of this offer, enter promo code 50EPINF24 at checkout. Don’t delay, order today!
Additional references and guidance may be found at the website of American Academy of Pediatrics:
The Centers for Medicare & Medicaid Services (CMS) is proposing targeted changes to the Long-Term Care Hospital (LTCH) Quality Reporting Program (QRP) in the fiscal
Grab your pens, alert your billing teams, and cue up your electronic medical record (EMR) vendors, because the Centers for Medicare & Medicaid Services (CMS)
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Stay ahead of Medicare Advantage’s 2025-2026 regulatory changes in this critical webcast featuring expert Tiffany Ferguson, LMSW, CMAC, ACM. Learn how new CMS rules limit MA plan denials, protect hospitals from retroactive claim reopenings, and modify Two-Midnight Rule enforcement—plus key insights on omitted SDoH mandates and heightened readmission scrutiny. Discover actionable strategies to safeguard revenue, ensure compliance, and adapt to evolving health equity priorities before the June 2025 deadline. Essential for hospitals, revenue cycle teams, and compliance professionals navigating MA’s shifting landscape.
Struggling with CMS’s 3-Day Payment Window? Join compliance expert Michael G. Calahan, PA, MBA, CCO, to master billing restrictions for pre-admission and inter-facility services. Learn how to avoid audit risks, optimize revenue cycle workflows, and ensure compliance across departments. Critical for C-suite leaders, providers, coders, revenue cycle teams, and compliance teams—this webcast delivers actionable strategies to protect reimbursements and meet federal regulations.
Providers face increasing Medicare audits when using skin substitute grafts, leaving many unprepared for claim denials and financial liabilities. Join veteran healthcare attorney Andrew B. Wachler, Esq., in this essential webcast and master the Medicare audit process, learn best practices for compliant billing and documentation, and mitigate fraud and abuse risks. With actionable insights and a live Q&A session, you’ll gain the tools to defend your practice and ensure compliance in this rapidly evolving landscape.
Dr. Ronald Hirsch dives into the basics of Medicare for clinicians to be successful as utilization review professionals. He’ll break down what Medicare does and doesn’t pay for, what services it provides and how hospitals get paid for providing those services – including both inpatient and outpatient. Learn how claims are prepared and how much patients must pay for their care. By attending our webcast, you will gain a new understanding of these issues and be better equipped to talk to patients, to their medical staff, and to their administrative team.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
