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  • Update: Nirsevimab (Beyfortus) Immunization and . . . - Blue Cross NC
    AMA ’s CPT Editorial Panel approved CPT codes 90380-90381 in May 2023 and released June 2023 The administration code with Nirsevimab is 96372 (injection, subcutaneous or intramuscular) Blue Cross NC has reviewed the information on Nirsevimab and will reimburse providers for the immunization
  • NCHB-CD-083465-25 Provider Billing Guide_DASH
    Prior to rendering a service that is not covered by Blue Cross NC, members must be informed that the service(s) to be rendered are not covered by North Carolina Medicaid, and they will have to pay for the service
  • How to use new CPT codes for administration of RSV immunizations
    New Current Procedural Terminology (CPT) codes have been approved for the administration of nirsevimab (Beyfortus), a monoclonal antibody designed to protect infants and toddlers from severe disease caused by respiratory syncytial virus (RSV) infection
  • Policies, guidelines and codes | Providers | Blue Cross NC
    These guidelines provide general information regarding the definition of Medical Necessary and Investigational Experimental services as defined by Blue Cross NC Additionally, a policy for participation in clinical trials is available as an administrative guideline
  • Beyfortus® Cost, Coverage, and Reimbursement | For US HCPs
    Q: Why do I need to provide the Beyfortus administration code when submitting a claim? A: The administration code must be provided in addition to the product code to be reimbursed for the service of administering Beyfortus
  • Services and CPT codes | Providers | Blue Cross NC
    Enter CPT and HCPCS codes in the search to determine if they require prior authorization Codes that require prior authorization will have a link to direct you to related requirements and instructions
  • Nirsevimab Coding Payment
    If counseling was not performed on the date of administration, 96381 is the correct code to report Do not report immunization administration codes 90460–90461 or 90471– 90472 for the administration of nirsevimab, as these codes are limited to administering vaccine and toxoid products
  • CC. PP. 030 - Add-On Code Billed Without Primary Code
    Code editing software evaluates claim lines on the current claim and in claims history for the presence of an add-on code billed with a primary code If an add-on code is billed and the primary code is not present on the current claim or a claim in history, the service line is denied
  • How to code RSV antibody injections and vaccines - AAFP
    Report the monoclonal antibody product itself with one of these two CPT codes: 90381 - Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use As
  • NC Medicaid Respiratory Syncytial Virus (RSV) Guidelines for 2024-2025
    This bulletin provides guidance on the 2024-2025 Respiratory Syncytial Virus (RSV) season for NC Medicaid and is based on products approved by the Food and Drug Administration (FDA) and recommended by the Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP)





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