Summary & Overview
CPT 90381: RSV Monoclonal Antibody Intramuscular Immunization, 1 mL
CPT code 90381 designates a monoclonal antibody product given intramuscularly as a seasonal, 1 mL dose to provide protection against respiratory syncytial virus (RSV). This code captures administration of a preventive biologic intended for outpatient or ambulatory immunization encounters. Nationally, RSV prevention is a public health priority for vulnerable populations, and accurate coding supports clinical documentation, reimbursement, and surveillance of immunization efforts.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical context, typical sites of service, and the administrative framing needed for billing and claims processing. The publication presents benchmarks where available, notes common billing modifiers, and highlights policy and coverage considerations relevant to payers and providers nationally.
This resource is intended to inform coding staff, revenue cycle professionals, and clinical leaders about the purpose and use of CPT code 90381, how it fits into immunization service lines, and the types of information payers commonly require for adjudication and reporting.
Billing Code Overview
CPT code 90381 represents a monoclonal antibody product administered intramuscularly to provide passive immunization against respiratory syncytial virus (RSV). This entry denotes a single, seasonal dose with an administered volume of 1 mL.
Service Type: Immunization / Preventive Injection
Typical Site of Service: Outpatient clinic, physician office, or other ambulatory care settings where intramuscular vaccinations are given
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Clinical & Coding Specifications
Clinical Context
A typical patient is an infant or high-risk pediatric patient during RSV season who presents for preventive immunization against respiratory syncytial virus. The patient is scheduled for an outpatient vaccination visit in a pediatric clinic, primary care office, or hospital-based ambulatory clinic. The clinical workflow includes verification of patient identity and eligibility, review of indications and contraindications, informed parental consent, documentation of weight and medical history (including prematurity, chronic lung disease, congenital heart disease, or immunocompromise), preparation of the monoclonal antibody product (1 mL dose), intramuscular administration using age-appropriate technique, and post-administration observation for immediate adverse reactions (typically 15–30 minutes). Documentation in the medical record includes the product name, lot number, expiration date, route (intramuscular), dose (1 mL), date and time of administration, administering provider taxonomy, and any adverse events. Billing is submitted under 90381 with appropriate modifiers if required by the payer (for example, reporting an unrelated evaluation/management service on the same day) and with the applicable diagnosis code reflecting RSV prophylaxis indication.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day |