Skip to Main Content

KMAP BULLETIN: Coverage for Nirsevimab (Beyfortus)

Date: 11/16/23

KMAP GENERAL BULLETIN 23269 (PDF)

Effective with dates of service on or after October 1, 2023, Medicaid will cover a new respiratory syncytial (RSV) monoclonal antibody Nirsevimab (Beyfortus) for all infants younger than 8 months, born during or entering their first RSV season. For immunocompromised children between the ages of 8 and 19 months who are at increased risk of severe RSV disease, a dose is recommended in their second season.

Children who are at an increased risk of severe RSV disease include the following:

  • Children with chronic lung disease of prematurity who required medical support (chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen) any time during the 6-month period before the start of the 2nd RSV season.
  • Children with severe immunocompromise.
  • Children with cystic fibrosis who have manifestations of severe lung disease (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest imaging that persist when stable) or weight-for-length <10th percentile.
  • American Indian or Alaska Native children.

The RSV Monoclonal Antibody CPT codes are 90380 and 90381.

Nirsevimab (Beyfortus) has been added to the Vaccines for Children (VFC) program and reimbursement will be for administration only.

Administrative Codes:

The administration code used for the injection of Nirsevimab (Beyfortus) should be as followed:

  • For service dates October 1-5, 2023: 96372 with modifier U2
  • For service dates on or after October 6, 2023: 96380 and 96381

The VFC administration rate is $20.26.

Effective October 6, 2023, administration code and modifier 96372 U2 should no longer be billed for administration of Nirsevimab (Beyfortus).

Note: The rates noted in this bulletin are subject to future changes. Providers should check the Kansas Medical Assistance Program (KMAP) website for the most up-to-date rates.

Note: The effective date of the policy is October 1, 2023. The implementation of State policy by the KanCare Managed Care Organizations (MCOs) may vary from the date noted in the KMAP bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates once the policy is implemented.