Thank you for being a Health Partners (Medicaid) and/or KidzPartners (CHIP) provider. This notice provides important information on the benefits/coverage for the vaccines Beyfortus and Abrysvo, both used in the treatment of RSV in children.

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

• Medicaid - Under the vaccines for children (VFC) program, Beyfortus is covered for children up to 24 months. As with any vaccine covered under the VFC program, Health Partners will cover the administration when billed as required per the terms of your contract.
• CHIP -  KidzPartners covers both the vaccine and the administration for children up to 24 months.

Abrysvo:  (90678-Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use)

• Medicaid -  Health Partners provides coverage for pregnant women between 32-36 weeks gestational age of pregnancy. Pregnant women under 18 years of age would be covered under the VFC program. Coverage is also available for adults 60+ years of age.
• CHIP - KidzPartners covers both the vaccine and the administration for pregnant women up to 18 years of age covered under the CHIP program.

Prior authorization is not required for either vaccine.

As a reminder, the vaccine administration fee will be reimbursed on the administration code, but only when both the vaccine code and the administration code are on the claim. Claims billed without both the vaccine code and the administration code will result in no payment. Jefferson Health Plans will also pay for the vaccine when appropriate.

RSV Administration codes effective 10/6/2023

• 96380 Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional
• 96381 Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection

If you have any questions, please call the Provider Services Helpline at 1-888-991-9023 (Monday - Friday, 9 a.m. to 5:30 p.m.).