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Thread: RSV and synagis cpt coding help

  1. #1

    Default RSV and synagis cpt coding help

    AAPC: Back to School
    Hello people, I'm new to this site and I was wondering if anybody could kindly help me out with coding issues I'm having.

    I wanted to know the correct way for billing the RSV test and synagis to the insurances below:

    1. Maryland Medicaid
    2. Amerigroup
    3. Priority Partners
    4. Maryland Physicians Care
    5. United Healthcare

    So far I came up with the synagis code being 90378, synagis administration code being 90460 and RSV Test being 87807 but anytime I bill any of these codes to the insurances above, they get rejected.

    I recently billed an RSV code to one of the insurance companies I listed above, but instead of typing in the RSV cpt code itself, I just typed in the ICD 9 code V04.82 (which is the need for prophylactic vaccination against respiratory synctial virus) and then the cpt code 99211 but I'm not particularly sure if that was a right approach.

    So if anyone could let me know what I'm doing wrong and tell me the correct way to deal with this issue, I would greatly appreciate it.

  2. #2


    Admin charge for synagis is 96372. 90378 for the synagis only if you purchase it. You could add an e/m code if the physician examines the patient for a separate issue with modifier 25. A great source of billing info can be obtained through your vendor.
    Last edited by lburke31; 02-20-2012 at 12:10 PM. Reason: ADDITONAL INFO

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