As a healthcare professional, it is important you receive the correct reimbursement for the care you provide. The information and resources on this page will give you and your staff everything needed to ensure you are billing and getting reimbursed correctly for administering Beyfortus® (nirsevimab-alip) 50 mg and 100 mg Injection.
Coverage
Beyfortus is covered by nearly 100% of commercial plans
Beyfortus may be available at no cost through private health insurance based on available information from national payer organization.
VFC Program
The Vaccines for Children (VFC) Program provides vaccines at no cost to children ages 18 or younger who are Medicaid-eligible, uninsured, underinsured, or American Indian/Alaska Native. It covers AAP-recommended vaccines, preventing cost barriers to immunization. It is federally funded, and available at participating providers.
Current Procedural Terminology (CPT) codes1
Beyfortus CPT codes can be found in the Immune Globulin section of CPT. On all claims for Beyfortus, choose one of these codes based on if a physician or other qualified healthcare professional (QHCP) provided counseling on the same date as the administration of Beyfortus:
CPT code 90380 or 90381 should be assigned on all claims for Beyfortus.
CPT code |
Description |
Use |
| 90380 | RSV, monoclonal antibody, seasonal dose; 0.5 mL dosage for IM use | Bill 1 unit of 90380 when a 0.5 mL dose is provided |
| 90381 | RSV, monoclonal antibody, seasonal dose; 1 mL dosage for IM use | Bill 1 unit of 90381 when a 1 mL dose is provided
Bill 2 units of 90381 when a 2 mL dose is provided |
Modifier -JZ
Some payers may require that modifier -JZ be added to the Beyfortus CPT code to show that the supplied dose size aligns exactly with the recommended dose size and the billing CPT code, resulting in zero discarded product.
When the payer requires -JZ modifier |
Description |
Use |
| JZ | Zero drug amount discarded/not administered to any patient | Attach to product code to show that the entire dose was administered |
Beyfortus Administration Codes
The administration of Beyfortus is reported in addition to the product code. Report the administration service with code 96380 or 96381 based on if a physician or other qualified healthcare professional (QHCP) provided counseling on the same date as the administration of Beyfortus.
CPT code |
Description |
Use |
| 96380 | Administration of RSV, monoclonal antibody, seasonal dose by IM injection, with counseling by physician or other QHCP | When counselling is performed by a provider who independently bills, such as physician or other QHCP, report 96380 with the Beyfortus product code 90380 or 90381 |
| 96381 | Administration of RSV, monoclonal antibody seasonal dose by IM injection | When counselling is not performed by a provider who independently bills, such as physician or other QHCP, report 96381 with the Beyfortus product code 90380 or 90381 |
Current Procedural Terminology (CPT) codes are a set of medical codes maintained by the American Medical Association and used by various entities to describe and report medical, surgical, and diagnostic services and procedures.
Beyfortus has 2 weight-based dosing options (50 mg and 100 mg). Therefore, to ensure proper billing and reimbursement, 2 CPT codes are necessary.2
Beyfortus product codes can be found in the Immune Globulin/mAb section of the CPT code book. This will be the first time that CPT and administration codes for a product on the immunization schedule will be in the Immune Globulin section.
The administration code must be provided in addition to the product code to be reimbursed for the service of administering Beyfortus.
Beyfortus is a monoclonal antibody; therefore, to be accurately reimbursed, the Immune Globulin administration codes must be used when submitting a claim.2
The 2 mL dose requires two 1 mL doses to be administered. When billing for the 2 mL dose, you must bill for two 1 mL doses by billing 2 units of CPT code 90381. You must also include the appropriate administration code to be reimbursed accurately.1,2
National Drug Code (NDC)1
To ensure correct billing and reimbursement, it is important to provide the correct Beyfortus NDC code. The Beyfortus NDC codes are:
Unit of sale NDC |
Unit of use NDC |
Presentation |
| 49281-575-15 | 49281-575-00 | Five 50 mg/0.5 mL single-dose pre-filled syringes in a carton |
| 49281-574-15 | 49281-574-88 | Five 100 mg/mL single-dose pre-filled syringes in a carton |
Each individual payer will determine which NDC number you should use when submitting for reimbursement.
Beyfortus has 2 weight-based dosing options (50 mg and 100 mg) available in a carton of 1 or 5 pre-filled syringes. Some payers, to ensure proper billing and reimbursement, will require the NDC code for the dosing option administered.2
ICD-10 code
Diagnosis code |
Use |
| Z29.11 | To ensure correct reimbursement for Beyfortus administration, be sure to use this code when submitting a claim. This ICD-10 code should be used following an encounter for prophylactic immunotherapy for RSV |
Stand-Alone Immunization Counseling1
Billing for counseling When the Immunization Is Not Administered
There are two sets of codes available for billing stand-alone immunization counseling: CPT codes (90482-90484) effective January 1, 2026, and HCPCS codes (G0310-G0315) effective since 2022. Medicaid and other payers may prefer HCPCS codes over CPT codes for billing, necessitating verification with payers regarding coverage and payment rates.
HCPCS code |
Description |
Use |
| G0310 | Immunization counseling by physician or other QHCP when immunization(s) is not administered by provider on the same date of service; 5–15 minutes | When a total of 5–15 minutes of stand-alone immunization counseling is provided by a physician or other QHCP to any age patient |
| G0311 | Immunization counseling by physician or other QHCP when immunization(s) is not administered by provider on the same date of service; 16–30 minutes | When a total of 16–30 minutes of stand-alone immunization counseling is provided by a physician or other QHCP to any age patient |
Immunization Counseling CPT Codes
The 3 immunization counseling CPT codes are based on the duration of counseling time: 3–10 minutes (90482), greater than 10 up to 20 minutes (90483), and greater than 20 minutes (90484). There is no upper limit for CPT 90484 so a prolonged service code cannot be used with this code set.
CPT code |
Description |
Use |
| 90482 | Immunization counseling by physician or other QHCP when immunization(s) is not administered by provider on the same date of service; 3 minutes up to 10 minutes | When a total of 3–10 minutes of stand-alone immunization counseling is provided by a QHCP |
| 90483 | Immunization counseling by physician or other QHCP when immunization(s) is not administered by provider on the same date of service; greater than 10 minutes up to 20 minutes | When a total of 11–20 minutes of stand-alone immunization counseling is provided by a QHCP |
| 90484 | Immunization counseling by physician or other QHCP when immunization(s) is not administered by provider on the same date of service; greater than 20 minutes | When a total of 21 minutes or more of stand-alone immunization counseling is provided by a QHCP |
Training
Cracking the Codes
Cracking the Codes provides comprehensive, on-demand training for the correct coding, billing, and reimbursement of Beyfortus at no cost. Their Provider Coverage Tool can be used to determine the coverage and reimbursement status of Beyfortus in your specific area and across the country.
Frequently asked questions
Yes—most plans cover Beyfortus.
The Affordable Care Act mandates that families with private insurance will have $0 out-of-pocket costs for an RSV preventive antibody, outside of rare exceptions.
Contact your insurance provider to confirm your coverage.
Yes. Beyfortus is part of the VFC Program.3
Children ages 18 years or younger who meet at least one of the following requirements4:
- American Indian or Alaska Native
- Medicaid-eligible
- Uninsured
- Underinsured
AAP, American Academy of Pediatrics; CDC, Centers for Disease Control and Prevention; HCPCS, Healthcare Common Procedure Coding System; ICD-10, International Classification of Diseases, Tenth Revision; IM, intramuscular; mAb, monoclonal antibody; RSV, respiratory syncytial virus.
Important Safety Information
References: 1. Data on File. Sanofi. 2. Beyfortus (nirsevimab-alip). Prescribing Information. Sanofi. 3. Addendum: Special considerations for COVID-19 vaccine and nirsevimab. Centers for Disease Control and Prevention. Updated March 29, 2024. Accessed June 1, 2026. https://www.cdc.gov/vaccines-for-children/media/pdfs/2024/08/operations-guide-covid-19-addendum-2024-4-2_002-508.pdf 4. Vaccines for children (VFC) program: Information for parents. Centers for Disease Control and Prevention. Updated September 30, 2025. Accessed June 1, 2026. https://www.cdc.gov/vaccines-for-children/vfc-information-for-parents/index.html
