New Respiratory Syncytial Virus (RSV) monoclonal antibody codes

Washington State Health Care Authority sent this bulletin at 11/15/2023 02:30 PM PST

November 15, 2023

Apple Health (Medicaid) Provider Alert

Attention providers

What changed?

Retroactive for claims with dates of service on and after October 1, 2023, the Health Care Authority (HCA) covers the following Respiratory Syncytial Virus (RSV) monoclonal antibodies:

CPT®

Code Short Description Modifier

90380 RSV MONOC ANTB SEASN .5ML IM SL

90381 RSV MONOC ANTB SEASN 1 ML IM SL

These vaccines are free from the Department of Health (DOH) for clients 18 years of age and younger under the Vaccines for Children (VFC) program.

Retroactive for claims with dates of service on and after October 6, 2023, the Health Care Authority (HCA) covers the following RSV monoclonal antibody administration codes:

CPT®

Code Short Description

96380 ADMIN RSV MONOC ANTB IM CNSL

96381 ADMIN RSV MONOC ANTB IM NJX

Fee Schedule

For more information, including maximum allowable fees, see HCA’s updated Professional administered drug, Physician-related services/Professional healthcare services, and Outpatient prospective payment system (OPPS) fee schedules on HCA’s Provider billing guides and fee schedules webpage.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

New Respiratory Syncytial Virus (RSV) monoclonal antibody codes

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination