Understanding the correct CPT codes for RSV vaccine and monoclonal antibody administration is important for accurate repayment and clean claim submission. For delivering the best medical billing services, precise coding directly affects revenue, compliance, and denial prevention. Incorrect code selection can result in delaying the payments, audits, and lost revenue. That is why partnering with the most reliable billing professionals that can support streamlining your claims process and enhancing repayment results.
What are CPT codes?
Current Procedural Terminology (CPT) codes are standardised procedure codes used to report medical, surgical, and diagnostic services. They are developed and sustained by the American Medical Association (AMA) through its CPT Editorial Panel. CPT codes serve as a universal language among providers and insurance payers.
For healthcare providers relying on expert medical billing services, fixes CPT reporting confirms:
- Quicker claim approvals.
- Lowered denials.
- Accurate repayment.
- Compliance with payer instructions.
When billing for RSV immunisations, providers must report:
- The vaccine or monoclonal antibody product code.
- The administration code.
- The correct ICD-10 detection code.
- Any need modifiers.
Most Common CPT Codes for RSV Vaccine and Antibody Administration
Some of the most frequently reported CPT codes related to RSV prevention:
CPT Code 96380
Administration of RSV monoclonal antibody by intramuscular injections with counselling by a physician or qualified healthcare professional. This code reflects the seasonal dose when counselling is provided during a similar visit.
Example:
A 6-month-old infant receives a 0.5ml dose of nirsevumab, and the provider offers the proper counselling regarding RSV prevention.
Billing Requirement:
- CPT: 96380.
- Product code (90380 or 90381).
- Diagnosis: Z29.11
Precise documentation is essential for claim approval, which is closely monitored by an experienced medical billing services team.
CPT Code 96381
Administration of RSV monoclonal antibodies by intramuscular injectables without any counselling requirement while the patient is taking a session. It is used when counselling was provided previously or separately.
Billing Requirement:
- CPT: 96380.
- Product code (90380 or 90381).
- Diagnosis: Z29.11
CPT Code 90380
RSV monoclonal antibody product, 0.5mL dose, intramuscular use. This code represents the drug substances only, not the administration. It is used for infants weighing less than 5kg.
CPT Code 90381
RSV monoclonal antibody product, 1mL dosages, intramuscular use. This code must be used for infants weighing 5 kg or more.
Important: Always bill this alongside the suitable administration code.
CPT Code 90678
Bivalent RSV vaccine, preF, subunit, intramuscular use.
Common brand: Abrysvo.
Indicated for:
- Adults aged 60 years and older.
- Pregnant patient between 32 and 36 weeks of gestation.
Billing Requirements:
CPT: 90678.
Administration: 90471.
Diagnosis: Z23.
Modifier 33 (if required by payer).
CPT Code 90679
RSV vaccine recombinant, subunit, adjuvanted, intramuscular usage.
Brand example: Arexvy.
Recommended for adults aged 60+.
CPT Coding 90683
RSV vaccine, mRNA lipid nanoparticles, intramuscular use.
Brand example: Mresvia.
Also suggested for adults aged 60+.
CPT Code 90471
Immunisation administration for one vaccine (intramuscular, subcutaneous, etc.)
This code covers:
- Vaccine administration.
- Documentation.
- Counselling (if applicable).
Used with product codes such as 90678, 90679, or 90683.
For practices outsourcing to DocVaz Medical Billing, accurate reporting of administration codes such as 90471 confirms compliance and optimal reimbursements.
Diagnosis Codes for RSV Immunisation
Common ICD-10 codes include:
- Z29.11 – Encounter for prophylactic immunotherapy for RSV.
- Z23 – Encounter for immunisation.
Professional medical billing services confirm these codes align correctly with product and administration CPT codes to avoid denials.
Why Accurate RSV Coding Matters?
Improper coding can result in:
- Claim denials.
- Delayed payments.
- Audit risks.
- Revenue loss.
By partnering with an experienced DocVaz Medical Billing, healthcare providers can:
- Enhances the first pass claim rates.
- Lowers AR days.
- Sustain regulatory compliance.
- Concentrates more on patient care.
Final Thoughts
Accurate reporting of RSV vaccine CPT codes is essential for compliance and proper repayments. From monoclonal antibody administration in infants to vaccination for older adults and pregnant patients, fixing the documentation and coding makes all the difference.
Healthcare providers who leverage expert medical billing facilities, such as those by our best company, can strengthen revenue cycle performance, lower the mistakes, and ensure clean claim submission every time.
FAQ’s
Do I bill both product and administration codes?
Yes, always report both the vaccine or antibody product codes and the administration code.
When must modifier 33 be used?
Modifier 33 is appended when the RSV vaccine is provided as a preventive facilities and the payer needs it to waive patient price sharing.
Which CPT code applies to pregnant patients?
CPT code 90678 is used for suitable pregnant patients 32 to 36 weeks of gestation.
Can multiple vaccines be billed during similar visits?
Yes, additional administration codes, such as 90472, might be required for additional vaccines.
How can medical billing services enhance RSV claim repayment?
Experienced billing teams confirm correct CPT, ICD-10 and modifier usages, verify payer instructions, and lower the denials through accurate documentation review.
