Coding for Reimbursement

Medicaid

For vaccines, remember to code for the vaccine product administered and the appropriate related vaccine administration code.

Check with your state agency or Medicaid managed care entity to determine any state specific coding, site of service or preferred network requirements.

Vaccine Product Coding

Use the CPT code that most accurately describes the vaccine product administered.

Vaccine Administration

Use the existing CPT immunization administration codes to describe the service based on the patient age and number of vaccines administered on the same day of service.

Based on your inputs:
  1. mRESVIA
  2. Medicaid
  3. Medical benefit
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CPT Code - Vaccine Product

Use the CPT code for the vaccine and dose administered.

mRESVIA® (Respiratory Syncytial Virus Vaccine) 50mcg/.5mL prefilled syringe

VACCINE CODE:
CPT 90683
Vaccine Descriptor:

Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use

CPT Code - Administration

Use the existing CPT immunization administration codes to describe the service based on the patient age and number of vaccines administered on the same day of service.
ADMINISTRATION CODE:
CPT 90471
ADMINISTRATION DESCRIPTOR:

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

ADMINISTRATION CODE:
CPT 90472
ADMINISTRATION DESCRIPTOR:

Immunization administration (each additional vaccine)

Additional Codes

ICD-10

DIAGNOSIS CODE:
Z23 Encounter for Immunization
DIAGNOSIS DOCUMENTATION:

Document the patient's situation and use consistent with the FDA authorization and CDC guidelines as appropriate.

CVX

CVX CODE:
326
CVX DESCRIPTOR:
  • RSV, mRNA, injectable, Respiratory syncytial virus (RSV), mRNA, injectable, preservative free
  • Used for registries as required.

For more details, visit our mRESVIA Frequently Asked Questions page.

Please see the mRESVIA Full Prescribing Information for more information.

mRESVIA Full Prescribing Information

The coding and billing information contained in this digital tool is provided as a resource and every effort is made to ensure the accuracy of this information. Appropriate coding and billing for healthcare services are the provider's responsibility and should always be based on the patient's clinical condition, services provided, and current payer guidelines.