Pulmonology Coding Alert

Is the RSV vaccine code ready for use?

Illinois Subscriber

Answer: That is correct: The 2023 CPT^® code set added 90678 (Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use) on Jan. 1, 2023. However, the respiratory syncytial virus (RSV) vaccine is still pending U.S. Food and Drug Administration (FDA) approval at the time of this publication. This means that providers can’t administer the RSV vaccine and receive reimbursement using 90678 and an appropriate administration code yet.

According to Appendix K of the American Medical Association (AMA) 2023 CPT^® code set, “Upon revision of the approval status by the FDA, notation of this revision will be provided by the AMA CPT^® ‘Category I Vaccine Codes’ website listing.” In addition to checking Appendix K for codes pending FDA approval, you can look for the lightning bolt symbol next to the code in the code set.

The vaccine represented by 90678 is a bivalent vaccine product, which means that it’s formulated to protect against two types of the RSV. The two prefusion (preF) proteins offer better inoculation against RSV A and B strains. Since 90678 represents the vaccine product, you’ll need to report a separate vaccine administration code as well.

RSV is a normally mild respiratory infection that affects the patient’s lungs and airways, but the virus can cause adverse effects in patients depending on their age and physical condition. Older adults, young children, and babies usually experience the most severe effects of the virus.

Learn more: Read about how to code RSV cases in the article “Are Your RSV Coding Skills Ready to Handle Rising Case Numbers?” in Pulmonology Coding Alert, Volume 23, Issue 12.