Editor's note: This story has been corrected to clarify that the new codes do not apply to palivizumab.
The American Medical Association has approved two new Current Procedural Terminology (CPT) codes related to the administration of nirsevimab for the prevention of respiratory syncytial virus (RSV), one of which values the work associated with providing counseling.
The new codes will give more pediatricians the ability to offer nirsevimab to families to protect their infants from respiratory syncytial virus (RSV).
“We have been eager to offer all infants this protection,” said AAP President Sandy L. Chung, M.D., FAAP. “Lifting this administrative barrier was a crucial step toward making it available and affordable in all communities.”
Nirsevimab is authorized for infants under 8 months of age during or entering their first RSV season and certain high-risk children 8-19 months of age entering their second season.
While nirsevimab prevents illness, the Food and Drug Administration has classified it as a drug, not a vaccine. That designation has led to some administrative barriers, including CPT codes that do not take counseling, storage/handling or reporting into consideration.
The product costs $495 per dose in the private sector and $395 per dose in the Vaccines for Children (VFC) program. Inadequate codes mean practices initially would have to provide nirsevimab at a loss but many do not have the overhead to do so.
In July, Dr. Chung sent a letter to federal health officials urging them to provide immediate support for pediatricians to ensure equitable access to nirsevimab. Her requests included payment for counseling.
“With declining immunization rates and an epidemic of vaccine misinformation and disinformation, pediatricians are trusted messengers and well-positioned to have conversations about immunizations with families — conversations that may be even more complicated with nirsevimab, she wrote.”
The new codes can be used for the administration nirsevimab:
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
The product codes for nirsevimab are:
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
The product code for palivizumab is:
90378 Respiratory syncytial virus, monoclonal antibody, recombinant, 50 mg
Improved CPT codes are a major step forward in administering nirsevimab. Dr. Chung has urged that they be part of a comprehensive strategy to ensure access to the product in hospitals, birthing centers and ambulatory practice settings. Some of the additional steps she called for were incorporated into the Centers for Disease Control and Prevention’s (CDC’s) updated VFC provider agreement on inventory and borrowing rules, providing additional flexibility in the program that serves children from low-income families.
“We will continue to advocate with manufacturers, distributors, governmental agencies and payers for changes we need in order to provide equitable access and care for our patients,” Dr. Chung said.
Resources
- AAP RSV resources, including information on ordering, dosing, coding and a visual guide for nirsevimab administration
- The AAP will hold a webinar on clinical considerations for prevention of RSV in children at 6 p.m. CDT Oct. 10 and a webinar on nirsevimab implementation strategies in outpatient practices at 7 p.m. CDT Oct. 17.
- Information for clinicians from the CDC on nirsevimab
- Information for parents from HealthyChildren.org on RSV symptoms and when to call a doctor
- Read the latest AAP News articles on RSV.
- Pediatrics in Review article, “Implications of Food and Drug Administration Approval of Respiratory Syncytial Virus Prophylactic Medications”
