What are the CPT Codes for RSV Vaccine?

Healthcare providers must know the correct CPT codes for RSV vaccine and antibody injections CPT codes. This is vital for accurate billing and prompt reimbursement.
Properly coding medical claims leads to faster acceptance. Errors in assigning CPT or other medical codes can cause problems. They can trigger audits and delay payments.
This guide covers the most common codes of CPT for RSV vaccine use in adults, children, and pregnant patients. Before we dive into specific codes, let’s explore the basics.
Medical Bills Consultancy helps healthcare providers with accurate coding for medical procedures. This ensures timely payments and reduces errors and audits.

What Are CPT Codes?

CPT codes are numerical codes. They identify medical, diagnostic, and surgical procedures and services. These codes create a standardized language in the healthcare industry. The CPT® Editorial Panel creates and maintains them with the AMA’s approval.
CPT codes are vital for identifying and diagnosing RSV vaccine use. They help optimize billing, claims, and public and private insurance compliance.

Standard Codes – CPT for RSV Vaccine

Here is a list of CPT for RSV vaccine use and counseling by healthcare professionals:

• 96380
• 96381
• 90380
• 90381
• 90678
• 90679
• 90683
• 90471

Let’s break down each of these codes and their applications in detail.

96380

This CPT code covers an RSV monoclonal antibody injection and patient counseling in one visit. It applies when the healthcare professional gives the RSV prophylactic and details on preventing RSV.
If a pediatrician gives a 0.5 mL nirsevimab (Beyfortus) to a 6-month-old and discusses RSV prevention with the parent, use Beyfortus 96380 CPT code for billing. Also, use diagnosis code Z29.11 for RSV immunotherapy.

CPT 96381

This code applies to giving a monoclonal antibody for RSV, with no counseling at the injection time. If a child gets an RSV vaccine follow-up dose without discussion, the provider will use 96381 for billing. They must note that counseling was provided earlier or is not required during this visit.
As with 96380, the diagnosis code Z29.11 should be included to reflect RSV immunotherapy.

90380 CPT Code

Code 90380 CPT is for a 0.5 mL seasonal dose of RSV monoclonal antibody via an intramuscular injection. This code is used when documenting the exact dosage of the monoclonal antibody.
A healthcare provider would use 90380 to record giving a 0.5 mL dose of nirsevimab to a child under 5 kg. It should be paired with the appropriate diagnosis code (Z29.11).

90381

Use CPT code 90381 to administer a 1 mL dose of RSV monoclonal antibody (for children over 5 kg). This code records the specific dosage given during RSV prophylaxis.
For example, a 6-month-old child weighing 6 kg gets a 1 mL dose of the RSV vaccine. Use the 90381 CPT code and the correct RSV administration and diagnosis codes.

90678 CPT Code Description

This code is for the bivalent RSV vaccine, preF, subunit. It is given by intramuscular injection. It is typically used for adults aged 60 and older or pregnant women between 32 and 36 weeks gestation.
For this vaccine, the bill uses code 90678. Use diagnosis code Z23 (immunization encounter) and administration code 90471. Add modifier 33 to show a cost-sharing exempt, preventive service if needed.

90679 CPT Code

CPT code 90679 applies to the Arexvy RSV vaccine. It is a recombinant subunit vaccine for adults 60 and older. Doctors administer it by intramuscular injection. Use this code for a vaccination appointment for an elderly patient. You must use it with the administration code 90471 and the relevant diagnosis code.

90683

This code is designated for the Mresvia mRNA-based RSV vaccine for adults 60 years and older. Use 90683 for the vaccine. Use 90471 for the admin. Use a diagnosis code to justify it.

90471 CPT Description

Use CPT code 90471 to report the administration of a CPT code for shingles vaccine. It includes intramuscular injections and any related counseling.
For example, to document the RSV vaccine given to a patient, use 90471. The diagnosis code Z23 should be added to reflect that the service was for immunization. Modifier 33 can be used if the vaccine is part of a preventive service exempt from cost-sharing.

Conclusion

Providers must use the correct codes CPT for RSV vaccine and antibody injections. It is critical to understand them. Proper docs ensure timely payment. They also avoid audits and billing issues. Use the correct CPT code when vaccinating children, adults, or pregnant patients.

FAQs

1. What are CPT codes used for?

Medical billing uses CPT codes for procedures and services. These codes simplify healthcare communication and claim processing. They create a common language for providers and insurers, covering diagnostics to surgery.

2. Why is it important to use the correct CPT code for the RSV vaccine?

Correct CPT coding makes billing easier, speeds up payments, and avoids scrutiny. Accurate codes ensure quick payments and prevent audits and delays.

3. What is CPT code 96380?

CPT 96380 covers both the injection and same-day counseling. Efficient coding for comprehensive care.