Billing reminder: RSV vaccine for pregnant women
February 12, 2024
This article is for obstetric providers and primary care providers caring for our members
As a reminder, we align with FDA recommendations and reimburse for the Respiratory Syncytial Virus (RSV) vaccine both for members aged 60+ and pregnant women within 32 to 36 weeks gestation.
When billing for the vaccine for pregnant women, please report the appropriate gestational week diagnosis on the claim to ensure accurate claim processing.
| RSV vaccine code | |
|---|---|
| 90678 | Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use |
| Gestational week diagnosis codes | |
| Z3A.32 | 32 weeks gestation of pregnancy |
| Z3A.33 | 33 weeks gestation of pregnancy |
| Z3A.34 | 34 weeks gestation of pregnancy |
| Z3A.35 | 35 weeks gestation of pregnancy |
| Z3A.36 | 36 weeks gestation of pregnancy |
Resources
- Immunizations payment policy
- Obstetrical and Maternity care payment policy
To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines> Payment Policies.
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