Primary Care Coding Alert

Question: What is the difference between all the new respiratory syncytial virus (RSV) vaccine product codes?

Maine Subscriber

Answer: Dosage and product composition are the main differences.

Codes 90678 (Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use) and 90679 (Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use) became effective in May of 2023. These vaccines are recommended for people ages 60 years and older. The following codes for RSV immunization product became available July 17, 2023:

• 90380 (Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use)
• 90381 (… 1 mL dosage, for intramuscular use)

Effective Jan. 1, 2024, code 90683 (Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use) will also be available.

Codes 90380 and 90381 represent the monoclonal antibody, which is used primarily for infants until they can build better immunity. Code 90683 is an mRNA lipid nanoparticle vaccine, which is similar to the COVID-19 vaccine’s composition, but the vaccine is not currently available since it’s awaiting U.S. Food & Drug Administration (FDA) approval. Once the FDA approves the product, providers may start reporting the code to receive reimbursement for the vaccine.

Important: Remember to include an appropriate vaccine administration code, such as 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)), for any of the vaccine products. Because 90380-90381 are monoclonal antibodies rather than vaccines, you will need to report the appropriate code from among 96365-96375 (Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug…).