© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 96380 refers to the administration of a seasonal dose of respiratory syncytial virus (RSV) monoclonal antibody via intramuscular injection. This procedure is specifically designed to provide protection against RSV, a virus that can cause severe respiratory illness, particularly in infants and young children. The monoclonal antibody used in this vaccine is engineered to mimic the immune response to RSV, helping the body to recognize and combat the virus effectively. The administration is typically performed as a single intramuscular injection, which is usually given in the anterolateral thigh, a common site for such vaccinations. This procedure is particularly important for infants and neonates who are entering their first RSV season, as well as for young children under the age of two who remain highly susceptible to the virus. Additionally, the code encompasses any face-to-face counseling provided by a physician or other qualified healthcare professional to the patient’s family or caregiver, ensuring that they are informed about the vaccine and its importance in preventing RSV-related complications.
© Copyright 2025 Coding Ahead. All rights reserved.
The administration of the respiratory syncytial virus (RSV) monoclonal antibody is indicated for specific populations at high risk of severe RSV disease. The following conditions warrant the use of this procedure:
The procedure for administering the RSV monoclonal antibody involves several key steps to ensure safety and efficacy:
Post-procedure care involves monitoring the patient for any immediate adverse reactions to the monoclonal antibody. Patients are typically observed for a brief period after the injection to ensure they do not experience any severe side effects. Families and caregivers are advised on what to expect following the vaccination, including common mild reactions such as soreness at the injection site or low-grade fever. Additionally, they are informed about the importance of follow-up appointments and any signs of complications that should prompt immediate medical attention. Overall, the goal of post-procedure care is to ensure the patient’s safety and to reinforce the importance of the RSV vaccination in preventing severe respiratory illness.
| Short Descr | ADMN RSV MONOC ANTB IM CNSL | Medium Descr | ADMN RSV MONOC ANTB SEASONAL DOS IM CNSL PHY/QHP | Long Descr | Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Not Billable to the MAC | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GA | Waiver of liability statement issued as required by payer policy, individual case | 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 |