CPT 90382 RSV Monoclonal Antibody Reimbursement

Headline: CPT code 90382: Intramuscular RSV Monoclonal Antibody (0.7 mL)

Lead: CPT code 90382 identifies a 0.7 mL intramuscular monoclonal antibody product used for prophylaxis against respiratory syncytial virus (RSV) during RSV season. The code captures administration of a preventive biologic in ambulatory settings and matters for national immunoprophylaxis policy, payer coverage determinations, and outpatient clinical operations.

CPT code 90382 is relevant nationally because RSV prevention is a seasonal public health priority for vulnerable populations, and monoclonal antibody prophylaxis affects outpatient workflows, inventory management, and payer benefit design. Key payers commonly included in coverage and reimbursement discussions are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will learn where this service is typically delivered, the clinical intent of the product (seasonal RSV prophylaxis), and what to expect in a national policy and payer coverage context. The publication will summarize benchmarking points, coding guidance, and recent policy developments relevant to outpatient administration of monoclonal antibody RSV prophylaxis. Data limitations: Data not available in the input for payer-specific rates, associated taxonomies, ICD-10 diagnoses, related codes, and service-line financial benchmarks.

Billing Code Overview

CPT code 90382 represents a monoclonal antibody product administered intramuscularly to help prevent respiratory syncytial virus (RSV) during RSV season. The coded dose is 0.7 mL.

Service type: Preventive biologic administration (monoclonal antibody prophylaxis)

Typical site of service: Outpatient clinic, physician office, or other ambulatory injection setting

Clinical Context

A full-term or preterm infant eligible for passive immunization against respiratory syncytial virus (RSV) presents to a pediatric clinic, newborn nursery, or public health vaccination clinic during RSV season for prophylaxis. The patient is assessed by a pediatrician or nurse practitioner to confirm weight-based dosing, absence of contraindications (e.g., severe allergic reaction to prior dose), and that the timing falls within the defined RSV season. The product labeled by CPT 90382 is prepared by pharmacy or nursing, drawn into a syringe (0.7 mL dose) and administered via intramuscular injection—typically into the anterolateral thigh for infants. Post-administration observation for immediate adverse reaction occurs for 15–30 minutes per clinic protocol. Documentation in the medical record includes the product name, lot number, dose (0.7 mL), route (IM), administration site, date/time, and any patient counseling provided. Billing is submitted with CPT 90382 and applicable modifiers to reflect special circumstances (for example, billed by the clinic administering the dose or adjusted for unusual circumstances). Typical sites of service include outpatient pediatric clinics, hospital-based outpatient vaccination clinics, or public health immunization centers. Common patient scenarios include infants with chronic lung disease of prematurity, hemodynamically significant congenital heart disease, or other high-risk conditions meeting local immunoprophylaxis guidelines who are scheduled for monthly or seasonally timed doses during the RSV season.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
`207Q00000X`	Pediatrics	Primary specialty that orders and administers RSV monoclonal prophylaxis for infants and children.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary encounter code used when documenting administration of RSV prophylaxis for preventive care.

| P07.30 | Preterm newborn, unspecified weeks of gestation, unspecified birth weight | Premature infants are a key high-risk population eligible for RSV prophylaxis.

| P27.1 | Bronchopulmonary dysplasia originating in the perinatal period | Infants with chronic lung disease are commonly indicated for RSV immunoprophylaxis.

| Q20.0 | Common arterial trunk | Representative congenital heart disease; hemodynamically significant cardiac disease increases RSV prophylaxis eligibility.

| D82.1 | Combined immunodeficiency | Infants with immunodeficiencies may be considered for RSV prophylaxis based on specialist guidance.

| Z91.19 | Patient's other noncompliance with medical treatment and regimen | May be used if adherence issues affect scheduling of seasonal prophylaxis (documentation purpose).

| Z00.129 | Encounter for routine child health examination without abnormal findings | Used for well-child visits during which RSV prophylaxis may be given.

| R07.9 | Chest pain, unspecified | Included as a symptomatic code that would prompt evaluation before administration if present; generally, acute illness may defer prophylaxis.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Used when an office documents administration of an IM injection for prophylaxis; some payers require reporting of the administration code in addition to the product code.

| 90460 | Immunization administration through 18 years of age, first or only component of each vaccine or toxoid administered | Use for pediatric immunization counseling and administration when payer policy distinguishes vaccine administration codes for children.

| 90461 | Each additional vaccine or toxoid component administered | Use if bundled administration rules require separate reporting for additional components (rare for single-agent monoclonal prophylaxis).

| 99070 | Supplies and materials (e.g., syringes, needles) used for administration, not included with service | Use when suppliers or payers allow separate reimbursement for administration supplies.

| 96361 | Therapeutic, prophylactic, or diagnostic injection; initial injection, intravenous push, single or initial substance/drug | Not typical for IM route but may be referenced in payer policies; included for workflow awareness.

| G0008 | Administration of influenza vaccine | Not directly related, but used in immunization clinics where multiple vaccine administration CPTs are billed; demonstrates administration code usage patterns.

OpenPayer

Summary & Overview

CPT 90382: RSV Monoclonal Antibody Intramuscular Injection, 0.7 mL