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CPT®
90381

CPT® Code 90381

Official Description

Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 90381 refers to a specific monoclonal antibody vaccine designed to provide protection against respiratory syncytial virus (RSV). This vaccine is administered in a 1 mL dosage via intramuscular injection. The primary function of this vaccine is to stimulate the recipient's immune system, enabling it to produce antibodies that can effectively combat RSV upon exposure. RSV is a highly contagious virus that is known to cause acute respiratory infections, particularly affecting infants, young children, and vulnerable populations such as the elderly or those with compromised immune systems. The virus typically circulates during the fall and winter months, making seasonal vaccination crucial for at-risk groups. The monoclonal antibody contained in this vaccine is engineered to mimic the natural immune response, providing a proactive defense against RSV. This is especially important for infants and neonates during their first RSV season, as they are at a heightened risk for severe illness, including pneumonia and potential hospitalization. The administration of this vaccine is a preventive measure aimed at reducing the incidence of RSV-related complications in young children and infants who are particularly susceptible to the virus.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The monoclonal antibody vaccine represented by CPT® Code 90381 is indicated for specific populations at high risk for severe respiratory syncytial virus (RSV) infection. The following conditions and circumstances warrant the administration of this vaccine:

  • Infants and Neonates: Particularly those entering their first RSV season, as they are highly susceptible to severe RSV infections.
  • Young Children Under Two Years: Children in this age group who remain at increased risk for RSV-related complications due to their developmental stage.
  • Immunocompromised Individuals: Those with weakened immune systems who may not be able to effectively fight off RSV infections.
  • Individuals with Chronic Conditions: Patients with underlying health issues such as congestive heart failure, asthma, or chronic obstructive pulmonary disease (COPD) that may exacerbate the severity of RSV infections.

2. Procedure

The administration of the monoclonal antibody vaccine involves several key procedural steps to ensure safety and efficacy:

  • Step 1: Patient Assessment Prior to administration, a thorough assessment of the patient’s medical history and current health status is conducted to confirm eligibility for the vaccine, particularly focusing on age and any underlying health conditions that may increase the risk of RSV infection.
  • Step 2: Preparation of the Vaccine The vaccine is prepared according to the manufacturer's guidelines, ensuring that the 1 mL dosage is accurately measured and that all necessary sterile techniques are employed to maintain the integrity of the vaccine.
  • Step 3: Administration The vaccine is administered via intramuscular injection, typically in the thigh for infants and young children. Proper injection techniques are followed to minimize discomfort and ensure effective delivery of the vaccine into the muscle tissue.
  • Step 4: Post-Administration Monitoring After the injection, the patient is monitored for a brief period to observe for any immediate adverse reactions or side effects, ensuring that any potential complications can be addressed promptly.

3. Post-Procedure

Following the administration of the monoclonal antibody vaccine, patients are generally advised to observe for any side effects, which may include mild reactions such as soreness at the injection site, low-grade fever, or irritability. It is important for caregivers to monitor the child for any unusual symptoms and to report these to a healthcare provider if they occur. The vaccine is intended to provide protection throughout the RSV season, and it is recommended that the administration occurs before the onset of the RSV season to maximize its effectiveness. Additionally, healthcare providers may offer guidance on ongoing preventive measures and monitoring for RSV symptoms during the season.
Short Descr RSV MONOC ANTB SEASN 1 ML IM
Medium Descr RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE
Long Descr Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use
Status Code Non-Covered Service
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 9 - Not Applicable
Multiple Procedures (51) 9 - Concept does not apply.
Bilateral Surgery (50) 9 - Concept does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 9 - Concept does not apply.
Co-Surgeons (62) 9 - Concept does not apply.
Team Surgery (66) 9 - Concept does not apply.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Items and Services Not Billable to the MAC
Type of Service (TOS) 1 - Medical Care
Berenson-Eggers TOS (BETOS) none
MUE 1
GY Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit
Date
Action
Notes
2024-01-01 Added First appearance in CodeBook
2023-07-17 Added Code released on June 30, 2023, FDA approval received and effective July 17, 2023.
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Description