Wiki New RSV vaccines?

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cnjacobs15

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Has anyone had any luck with any insurances adding the new RSV vaccines to their fee schedules yet? I keep checking fee schedules for our major payers but no one has added them yet with a fee... also been trying to stay on top of newsletters and articles but just haven't found anything yet.
Adult RSV CPT 90678 90679 and CPT codes 90380 90381. we are trying to prepare the best we can for being able to offer the vaccines to patients but are at a standstill until the insurances get on board..
 
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cnjacobs15 said:
Has anyone had any luck with any insurances adding the new RSV vaccines to their fee schedules yet? I keep checking fee schedules for our major payers but no one has added them yet with a fee... also been trying to stay on top of newsletters and articles but just haven't found anything yet.
Adult RSV CPT 90678 90679 and CPT codes 90380 90381. we are trying to prepare the best we can for being able to offer the vaccines to patients but are at a standstill until the insurances get on board..
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Our pediatric office would like to offer this vaccine to our patients but I have not found it on any fee schedule as of today. and RSV season is coming up fast. I will respond to this thread as soon as i can find any information out.
 
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nancydawson said:
I am having issues also!!! It's mid September!!!!!
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I saw yesterday that Highmark of PA released a bulletin on 09/15/23 stating they have added the RSV vaccines to their Preventive Schedule for Infants and Adults. but they already have their proposed fee schedule out that will be effective 10/01/23 for the 4th quarter and none of the codes are on it! i am hoping now that they added it to the medical policy they get them added prior to 10/01... I see that you are in WV so i am not sure if this update pertains to Highmark of WV as well.

Aetna has also updated their medical policies.
https://www.aetna.com/cpb/medical/data/1000_1099/1038.html

The medical policies are a plus but until we have fees and they will accept the codes our hands are tied! I even yelled at the TV last night when the Arexvy RSV vaccine commercial came on because we cannot administer them yet!! they are haunting me. and now to add the Covid vaccines to it! I had a thought that maybe they were waiting for the covid vaccine changes to be finalized and will just update all at once. (one can hope right)
 

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I have located my first RSV vaccine fee! Aetna added their fee of 90678. $300.08! Slowly but shortly they are adding!
p.s Aetna also added their fees for all of the new covid vaccine codes and admin code. they priced the same as medicare.
and capital blue added the covid admin code to their fee schedule.
 
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aharris1213 said:
Are we able to use Z23 or not because it technically isn't a vaccine?
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Pfizer's Abrysvo 90678 and GSK's Arexvy 90679 are both considered vaccines
And even though Beyfortus 90380 90381 is not technically a vaccine Z23 is still to be used.
Unless a 2-mL dose is adminsited due to a highrisk condition then Z29.11 Encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV) is used.
here is the coding and billing tip sheets i have.
 

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  • Beyfortus Coding and Billing Sheet.pdf
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  • AREXVY Billing and Coding.pdf
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  • Abrysvo Billing and Coding.pdf
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aharris1213 said:
Are we able to use Z23 or not because it technically isn't a vaccine?
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I may have spoken too soon... Based on the Billing and coding guide that we were given Z23 can be used. but per this article the AAP released last week Z23 should not be used.... and now there are new admin codes! 96380 96381.


We are starting to administer to children and are getting claim edit errors when they are administering the 90380/90381 as well as other vaccines because 96372 is bundled with 90460/90461..

So now we are conflicted because the payers all have 96372 as the admin code and to associate Z23 on their medical policies. the billing and coding guide from the company states 96372 and Z23.. but the AAP's article states 96380 96381 are the admin codes and Z23 should not be used Z29.11 is the dx code..

So at this point we are not sure what to do or how to bill! I did notice the article stated that they are urging the payers to update the admin codes ASAP...
 
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