Cost & Coverage
Beyfortus® (nirsevimab-alip) 50 mg and 100 mg injection reimbursement resources
The resources you need to be properly reimbursed for administering Beyfortus
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 reimbursed correctly for administering Beyfortus.
How and when to use the Beyfortus codes
CPT® codes 90380 and 90381 are specifically for Beyfortus. Beyfortus CPT codes can be found in the Immune Globulin section. On all claims for Beyfortus, choose one of these codes based on the size of the dose provided.¹
- Use CPT code 90380 when a single 0.5 mL dose is administered
- Use CPT code 90381 when a single 1 mL dose or a 2 mL dose (two 1 mL doses) are administered
On October 6, 2023 CPT released 2 new codes to report the administration of Beyfortus, effective immediately. 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.
During the transition to these new codes, payer policies may require reporting administration CPT code 96372 for therapeutic, prophylactic, or diagnostic injection until their coverage policies and payment systems are ready to accept claims using CPT 96380 and 96381. Contact the health plans that you work with to verify their coding requirements and to see when they will be ready to accept the new administration codes 96380 and 96381.
- Use CPT code 96380 when counseling is performed by a provider who independently bills, such as a physician or other qualified health care professional
- Use CPT code 96381 when counseling is not performed by a provider who independently bills, such as a physician or other qualified health care professional
During the transition to these new codes, payer policies may require reporting administration CPT code 96372 for therapeutic, prophylactic, or diagnostic injection until their coverage policies and payment systems are ready to accept claims using CPT 96380 and 96381. Contact the health plans that you work with to verify their coding requirements and to see when they will be ready to accept the new administration codes 96380 and 96381.
To ensure correct billing and reimbursement it is important to provide the correct Beyfortus NDC code. The Beyfortus NDC codes are
- 50 mg/0.5 mL prefilled syringe: Carton of 5, NDC 49281-575-15 (Unit of Sale NDC)
- 100 mg/1 mL prefilled syringe: Carton of 5, NDC 49281-574-15 (Unit of Sale NDC)
| 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 |
To ensure correct reimbursement for Beyfortus administration, be sure to use ICD-10-CM diagnosis code Z29.11 when submitting a claim. This ICD-10 code should be used following an encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV).
Q: What is a CPT code?
A: 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.
Q: Why does Beyfortus have 2 CPT codes?
A: Beyfortus has 2 weight-based dosing options (50 mg and 100 mg). Therefore, to ensure proper billing and reimbursement, 2 CPT codes are necessary.
Q: When billing, should I use the unit of use or carton NDC number?
A: Each individual payer will determine which NDC number you should use when submitting for reimbursement.
Q: What ICD-10 codes should I use when submitting for reimbursement?
A: The ICD-10-CM diagnosis code Z29.11 should be used when submitting a claim for Beyforttus administration. The description for this ICD-10 code is an encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV).
Q: Where do I find the Immune Globulin section?
A: 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.
Q: Why is Beyfortus reimbursed using immune globulin administration codes instead of vaccine administration codes?
A: Although ACIP has added Beyfortus to the infant immunization schedule, it is a monoclonal antibody.³ Therefore, to be accurately reimbursed, the immune globulin administration codes must be used when submitting a claim.
Q: Why do I need to provide the Beyfortus administration code when submitting a claim?
A: The administration code must be provided in addition to the product code to be reimbursed for the service of administering Beyfortus.
Q: Why do I need to provide the Beyfortus NDC code when submitting a claim?
A: Beyfortus has 2 weight-based dosing options (50 mg and 100 mg) available in a carton of 5 pre-filled syringes. Some payers, to ensure proper billing and reimbursement, will require the NDC code for the dosing option administered.
Q: How do I bill for the 2 mL dose?
A: The 2 mL dose requires two 1 mL doses to be administered. When billing for a 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 coding to be reimbursed accurately.
A: 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.
Q: Why does Beyfortus have 2 CPT codes?
A: Beyfortus has 2 weight-based dosing options (50 mg and 100 mg). Therefore, to ensure proper billing and reimbursement, 2 CPT codes are necessary.
Q: When billing, should I use the unit of use or carton NDC number?
A: Each individual payer will determine which NDC number you should use when submitting for reimbursement.
Q: What ICD-10 codes should I use when submitting for reimbursement?
A: The ICD-10-CM diagnosis code Z29.11 should be used when submitting a claim for Beyforttus administration. The description for this ICD-10 code is an encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV).
Q: Where do I find the Immune Globulin section?
A: 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.
Q: Why is Beyfortus reimbursed using immune globulin administration codes instead of vaccine administration codes?
A: Although ACIP has added Beyfortus to the infant immunization schedule, it is a monoclonal antibody.³ Therefore, to be accurately reimbursed, the immune globulin administration codes must be used when submitting a claim.
Q: Why do I need to provide the Beyfortus administration code when submitting a claim?
A: The administration code must be provided in addition to the product code to be reimbursed for the service of administering Beyfortus.
Q: Why do I need to provide the Beyfortus NDC code when submitting a claim?
A: Beyfortus has 2 weight-based dosing options (50 mg and 100 mg) available in a carton of 5 pre-filled syringes. Some payers, to ensure proper billing and reimbursement, will require the NDC code for the dosing option administered.
Q: How do I bill for the 2 mL dose?
A: The 2 mL dose requires two 1 mL doses to be administered. When billing for a 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 coding to be reimbursed accurately.
Comprehensive, on-demand training for the correct coding, billing, and reimbursement of Beyfortus is available at no cost.
crackingthecodestraining.com.
crackingthecodestraining.com.
The Provider Coverage Tool can be used to determine the coverage and reimbursement status of Beyfortus in your specific area and across the country.
This easy-to-use tool can be accessed through crackingthecodestraining.com.
This easy-to-use tool can be accessed through crackingthecodestraining.com.
