CPT Reporting for RSV Prophylaxis

Respiratory Syncytial Virus

Respiratory Syncytial Virus, more commonly referred to as RSV, is a virus that causes infection of the respiratory tract, including the nose, throat and lungs, and is slightly more contagious than other respiratory viruses. In healthy adults and children, symptoms of RSV infection are similar to the common cold. Infection in infants/children, the elderly, immunocompromised patients or patients with certain comorbidities, such as asthma/COPD or congestive heart failure, can be serious or potentially life threatening.

RSV Prophylaxis

There are two vaccinations against RSV approved for use in adults 60+.

• GSK – Arexvy
• Pfizer – Abrysvo

Abrysvo is also approved for use in adult pregnant patients during weeks 32 thru 36 of pregnancy to stimulate production of maternal antibodies which in turn provide passive immunization of the infant for up to 6 months after birth.

Protection against RSV in some infants and children is offered through immunization with monoclonal antibodies administered via intramuscular injection. There are two RSV monoclonal antibody medications.

• Beyfortus
• Nirsevimab

CPT Coding

Coders must carefully identify the product that was administered for RSV prophylaxis as code assignment is different dependent on whether the patient is immunized with a vaccination or monoclonal antibodies, and the specific immunization product.

Vaccination

All vaccinations require the assignment of two codes, one code for administration of the vaccination, the actual injection of the drug, and one code for the specific vaccination product that was administered.

Administration of an RSV vaccination is reported with codes from the Immunization Administration subsection of CPT. Codes 90460-90461 are assigned if face-to-face counseling is provided in conjunction with administering the vaccination or 90471-90472, if counseling is not provided.

• 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; first or only component of each vaccine or toxoid administered
• +90461 each additional vaccine or toxoid component administered
• 90471 Immunization administration (included percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
• +90472 each additional vaccine (single or combination vaccine/toxoid)

The codes available to report RSV vaccination products, 90678, 90679 and 90683, come from the Vaccine, Toxoids subsection. These codes are differentiated by type of vaccine, but they are all for intramuscular use.

• 90678 Respiratory syncytial virus vaccine, preF, subunit, bivalent for intramuscular use
• 90679 Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted for intramuscular use
• 90683 Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use

Monoclonal Antibodies

Coding for administration of RSV monoclonal antibodies also requires assignment of a code for the administration of the immunization and a code that identifies the specific product that was administered.

Administration of products that are serum globulin or recombinant immune globulin products is coded from the Therapeutic, Prophylactic and Diagnostic Injection and Infusion subsection rather than in the subsection for Immunization Administration.

The codes for the RSV monoclonal antibody immunization products come from the Immune Globulins, Serum or Recombinant Products subsection rather than from the Vaccines, Toxoids subsection.

CPT has two types of RSV monoclonal antibody products, a recombinant product and a seasonal dose product. The administration codes for each product are different.

Recombinant

Code 90378 is assigned to specify that it was recombinant RSV monoclonal antibody that was administered. This code reports administration of 50 mg of medication. The code description states, “each” indicating that more than one dose may be administered.

• 90738 Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each.

The code to report for administration of recombinant, RSV monoclonal antibodies is 96372. Assignment of this code is based on intramuscular injection as the method of administration.

• 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

Seasonal Dose

For 2025, two new codes, 96380 and 96381, were added to report administration of a seasonal dose of monoclonal antibodies for RSV prophylaxis.

• 96380 Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional
• 96381 Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection

Note: Assignment of 96380 requires provision of counseling by a physician or other qualified healthcare professional.

Either code 90380 or 90381, is needed to report that the specific medication administered is respiratory syncytial virus, monoclonal antibody, seasonal dose. Selection of the pertinent code depends on the size of the dose that was administered.

• 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

Summary Table

Take Aways

• Immunization against RSV is achieved by administration of a vaccination or monoclonal antibodies
• Vaccinations are available for adults 60+ and pregnant adults during weeks 32-36 of pregnancy
• Monoclonal antibody products are available for select infants and children
• Coding for vaccinations requires reporting a code for administration of the vaccine from the Immunization Administration for Vaccines/Toxoids subsection of CPT and a code for the specific vaccine product from the Vaccine/Toxoids subsection
• Coding for monoclonal antibodies requires reporting a code for administration of the monoclonal antibody from the Therapeutic, Prophylactic and Diagnostic Injection and Infusion subsection of CPT and a code for the specific immunization product from the Immune Globulins, Serum or Recombinant Products subsection
• Assignment of certain codes requires concomitant provision of counseling by a physician or other qualified healthcare professional

References

• CPT® Codebook
• https://www.healthline.com/health/how-contagious-is-rsv
• https://www.cdc.gov/rsv/vaccines/protect-infants.html

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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.