Beyfortus (Nirsevimab) Immunization and Reimbursement

Beyfortus (nirsevimab), a monoclonal antibody, is administered to newborns and infants once during their first RSVseason and again in the second RSVseason to children up to 19 months of age, as clinically indicated by Advisory Committee on Immunization Practices’ (ACIP) and American Academy of Pediatrics (AAP).  AMA’s CPTEditorial 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 and Blue Shield of North Carolina (Blue Cross NC) has reviewed the information on nirsevimab and will reimburse providers for the immunization. If an evaluative or preventative service is being coded and billed with administration of nirsevimab, it must be appended with an appropriate modifier, such as -25 or -59, to indicate the services are separate and distinct.