Four new vaccine product codes and two new immune globulin codes were established in the Current Procedural Terminology (CPT) 2024 code set. This article provides an overview of these new codes.
Immune Globulins, Serum or Recombinant Products
90380 Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use
903811 mL dosage, for intramuscular use
Vaccines, Toxoids
90589 Chikungunya virus vaccine, live attenuated, for intramuscular use
90679 Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use
90683 Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use
(For seasonal respiratory syncytial virus [RSV] monoclonal antibodies immunization codes, see 90380, 90381. For administration of seasonal RSV monoclonal antibodies immunizations, use 96372)
90623 Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y- tetanus toxoid carrier, and Men B-FHbp, for intramuscular use
Immune Globulin Codes
During the May 2023 CPT Editorial Panel (the Panel) meeting, the Panel approved two new codes (90380, 90381) representing a new monoclonal antibody product to provide passive immunization to infants and children to prevent respiratory syncytial virus (RSV). This monoclonal antibody product may be administered to infants under 8 months of age who are entering their first RSV season and may also be considered for infants and children 8 through 19 months of age who meet specific criteria (severe chronic lung disease, immunocompromised, diagnosed with cystic fibrosis, American Indian and Native Alaskan children) before their second RSV season.1 Administration of these monoclonal antibody products should be reported using code 96380 or 96381, as appropriate. Refer to the November 2023 issue of CPT Assistant for additional details on these two administration codes.
Vaccine Product Codes
For the CPT 2024 code set, four new vaccine Category I codes were added for new vaccines. Vaccine product code 90589 represents a new vaccine for the chikungunya virus. Chikungunya virus is transmitted by mosquitos and is mostly seen in countries in Africa, the Americas, Asia, Europe, the Caribbean, and the Indian and Pacific Oceans. Patients infected with the chikungunya virus present with similar symptoms as those infected with dengue or zika virus, so it can be difficult to diagnose.2,3 Patients commonly experience fever and joint/muscle pain, as well as headache, nausea, fatigue, and rash.2,3 While death is rare, those at the extremes of age (infants/children and the elderly), as well as those who are immunocompromised, are most at risk for severe disease.2,3 The vaccine product represented by code 90589 is the first vaccine approved for chikungunya virus and is indicated for use as a single-dose injection for those aged 18 years and older, who are at increased risk of exposure to chikungunya virus.4
Vaccine product code 90679 represents a new vaccine product code for RSV. This vaccine is intended for use in adults aged 60 years and older to prevent severe respiratory disease due to RSV and should be administered as soon as it is available before the start of the RSV season.5
Vaccine product code 90683 represents another new vaccine product for RSV. This RSV vaccine has yet to receive Food and Drug Administration (FDA) approval. This RSV vaccine differs from other RSV vaccines because it uses messenger ribonucleic acid (mRNA) technology similar to that used in some severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccines. This vaccine is intended for use in adults 60 years of age and older to prevent severe respiratory disease due to RSV. These two products differ from the RSV vaccine product represented by code 90678, Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use, that was discussed in the February 2023 issue of CPT Assistant, which is intended for use in adults aged 60 years and older, as well as for adults in their second or third trimester of pregnancy.
Lastly, vaccine product code 90623 represents a new pentavalent meningococcal vaccine. Unlike other meningococcal vaccines, this new pentavalent vaccine includes all five serogroups in one vaccine (A, C, W, Y, with B). Currently, most meningococcal vaccines include groups A, C, W, and Y. There are separate, monovalent vaccines available that protect against Group B. This new pentavalent vaccine is intended for use in those aged 16 through 23, as well as patients aged 10 and older who have certain comorbidities.
These vaccine product codes should be reported with the appropriate vaccine administration code (90461, 90462, 90471, 90472) based on the age of the patient and the number of vaccines administered during the encounter.
The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.
Clinical Example (90380)
A parent or guardian of a child seeks protection for their child against the respiratory syncytial virus (RSV) infection to decrease the risk of contracting this disease. The physician or other qualified health care professional (QHP) determines that the child is an appropriate candidate for RSV immunization and orders its administration.
Description of Procedure (90380)
The physician or other QHP selects the appropriate RSV immunization dosage, obtains informed consent from the child‘s parent or guardian, and dispenses a dose of the RSV immunoglobulin. Report the administration of the immunoglobulin separately.
Clinical Example (90381)
A parent or guardian of a child seeks protection for their child against RSV infection to decrease the risk of contracting this disease. The physician or other QHP determines that the child is an appropriate candidate for RSV immunization and orders its administration.
Description of Procedure (90381)
The physician or other QHP selects the appropriate RSV immunization dosage, obtains informed consent from the child‘s parent or guardian, and dispenses the dose of the RSV immunoglobulin. Report the administration of the immunoglobulin separately.
Clinical Example (90589)
A 45-year-old female visits her physician or other QHP because she will be traveling to Africa on business. After assessing her itinerary and risk of exposure to mosquitos, the physician or other QHP recommends immunization against chikungunya virus and orders administration of the vaccine.
Description of Procedure (90589)
The physician or other QHP confirms the need for vaccination against chikungunya virus. After counseling and obtaining informed consent, reconstitute the vaccine and administer intramuscularly. Record the vaccination and report the vaccination administration separately.
Clinical Example (90679)
A 67-year-old male presents for evaluation, and the physician or other QHP determines that he should receive the RSV vaccine and orders its administration.
Description of Procedure (90679)
The physician or other QHP selects the appropriate RSV vaccine. After counseling and obtaining informed consent, administer the immunization intramuscularly. Report the vaccine administration separately from the vaccine product.
Clinical Example (90683)
A 60-year-old female is seen for a preventive medicine visit. In accordance with the national recommendations for immunizations, the physician determines that a vaccine to prevent RSV-associated lower respiratory tract disease (LRTD) is recommended for the patient. The patient is offered and agrees to an intramuscular injection of an RSV vaccine for this purpose.
Description of Procedure (90683)
The physician or other QHP reviews the patient‘s chart to confirm that vaccination to prevent RSV-associated LRTD is indicated. Obtain informed consent and dispense a dose of the RSV vaccine.
Clinical Example (90623)
A parent or guardian of a child seeks immunization for the child against meningococcal infection to decrease the risk of contracting the disease. The physician or other QHP determines that the child is an appropriate candidate for the pentavalent meningococcal vaccine and orders its administration.
Description of Procedure (90623)
A physician or other QHP determines that the pentavalent meningococcal vaccine is appropriate for this patient. After counseling and obtaining informed consent, administer the immunization intramuscularly. Report the vaccination administration separately from the vaccine product.
References
Centers for Disease Control and Prevention. Respiratory syncytial virus for healthcare providers. Accessed November 3, 2023. https://www.cdc.gov/rsv/clinical/index.html.
World Health Organization. Chikungunya. Accessed November 3, 2023. https://www.who.int/news-room/fact-sheets/detail/chikungunya.
Centers for Disease Control and Prevention. Chikungunya virus. Accessed November 3, 2023. https://www.cdc.gov/chikungunya/index.html.
Food and Drug Administration. FDA approves first vaccine to prevent disease caused by chikungunya virus. Accessed November 30, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-first-vaccine-prevent-disease-caused-chikungunya-virus.
Centers for Disease Control and Prevention. RSV vaccination for older adults 60 years of age and over. Accessed November 3, 2023. https://www.cdc.gov/vaccines/vpd/rsv/public/older-adults.html.