Update to Respiratory Syncytial Virus (RSV) Vaccination Claims Guidance
On September 15, 2023, the Office of MaineCare Services (OMS) sent a bulletin regarding the coverage of RSV vaccines.
OMS has completed the update to our systems, and you may begin to submit claims for these services.
These rates are applicable only to vaccines that have been directly purchased. Any vaccine that is received via government supply or through the Vaccines for Children’s program will require the use of the SL modifier and will be reimbursed at $0.
Please review the following table for more information.
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Respiratory Syncytial Virus (RSV) Vaccination Codes |
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Code |
Description |
Effective Date |
Rate |
|
90380 |
Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use |
07/17/2023 |
$0* |
|
90381 |
Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use |
07/17/2023 |
$0* |
|
90678 |
Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use |
05/31/2023 |
$298.69 |
|
90679 |
Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use |
05/03/2023 |
$284.60 |
|
96380 |
Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional |
10/06/2023 |
$15.59 |
|
96381 |
Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection |
10/06/2023 |
$13.44 |
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*Government Supplied Vaccine |
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If you have questions about the RSV vaccine or its administration, please contact your Provider Relations Specialist.
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