Update: Nirsevimab (Beyfortus) Immunization and Reimbursement

Update October 23, 2023: On October 6, 2023, CPT created new administration codes (96380 and 96381) for Beyfortus. These two new codes replace the previously instructed generic drug administration code 96372. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) encourages providers to immediately start using these new administration codes to more accurately describe Beyfortus administration moving forward.

See the original Beyfortus (Nirsevimab) article. 

Beyfortus (Nirsevimab), a monoclonal antibody, is administered to newborns and infants once during their first RSV season and again in the second RSV season to children up to 19 months of age, as clinically indicated in this recommendation for Nirsevimab by Advisory Committee on Immunization Practices’ (ACIP) and American Academy of Pediatrics (AAP). 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. 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.