Obtain Maximum Reimbursement for the Maternal Respiratory Syncytial Virus (RSV) Vaccine (Abrysvo): Administration, Storage and Coding Tips for Obstetricians

Published January 2025

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• The maternal respiratory syncytial virus (RSV) vaccine (Pfizer’s Abrysvo) now has a new seasonal CPT code for administration, effective for dates of service on and after October 6, 2023.
• Administering Abrysvo to pregnant patients can help protect newborns and infants against severe RSV lower respiratory tract infection (LRTI) in the first six months after birth. See ACOG’s Practice Advisory, Maternal RSV Vaccination Frequently Asked Questions, and Seven Things to Share with Your Patients About the Maternal RSV Vaccine for additional information and counseling considerations.

Vaccine Codes for Abrysvo

This table was adapted from "Table 8. Coding for RSV Vaccine Administration" in Immunization Coding for Obstetrician-Gynecologists.

Administration & Storage Tips

• Administer Abrysvo within the correct timeframe to ensure full reimbursement. It can be given to pregnant patients at 32 0/7 through 36 6/7 weeks gestation in a single dose. Administration beyond 36 weeks 6 days is not recommended, as there may not be enough time for antibodies to transfer and provide protection.
• Administer Abrysvo seasonally (September 1 to January 31 in most of the U.S.). In areas where RSV seasonality differs, follow state, local, or territorial guidance.
• Abrysvo should not be given in subsequent pregnancies due to limited data on effectiveness. In subsequent pregnancies, administration of the RSV monoclonal antibody nirsevimab is recommended.
• After administration, the unopened, refrigerated shelf life for Pfizer’s Abrysvo is 36 months at standard refrigerator temperatures (36°F to 46°F / 2°C to 8°C).
  • Regularly monitor the vaccine’s expiration date. Discard any expired vaccine.
  • Any non-expired vaccine may be used in the following respiratory season to reduce waste and costs.

Coding Tips

ICD-10-CM Codes

• Document the gestational age at the time of vaccination using the correct ICD-10-CM diagnosis codes (Z3A.32 through Z3A.36).
• Include additional relevant ICD-10-CM codes indicating a vaccine was administered during a pregnancy visit:
  • Z23 (vaccine encounter). If Z23 is not accepted as the primary diagnosis, try Z29.11 (encounter for prophylactic immunotherapy for RSV).
  • Include the appropriate pregnancy encounter code: Z34 family or O-family codes, as ICD-10-CM guidelines require all pregnancy-related services to have a Chapter 15 ("O" codes) primary diagnosis.

CPT Codes

• Check payer-specific coding requirements for Abrysvo.
• Document the Abrysvo CPT code (90678).
• Use the appropriate administration codes:
  • 90471 (for one vaccine in patients over age 18)
  • AND 90472 (if a second vaccine is given at the same visit in patients over age 18)
  • 90460 (for patients through age 18 when vaccine counseling is provided)
  • AND 90461 (for patients through age 18 if a second vaccine is given at the same visit)

• Some payers may require modifier 33 on the administration code to indicate the service was preventive and exempt from patient cost-sharing. Check payer coding guidelines.
• If distinct vaccine counseling beyond the standard administration is documented, an E/M visit code may also be billed.

Coding Scenarios

1. A 34-week pregnant woman is given the maternal RSV vaccine (Abrysvo). Which of the following are the correct ICD-10-CM codes for a routine prenatal visit with the administration of the RSV vaccine?
   1. Z34.83, Z3A.34
   2. Z34.32, Z24
   3. Z34.92, Z3A.32
   4. Z23, Z3A.34

2. A 30-year-old pregnant woman presents at 32 weeks gestation to the clinic for the administration of the maternal RSV vaccine (Abrysvo). Which of the following are the correct CPT codes for the vaccine code and the administration of the vaccine?
   1. 96372, 90683
   2. 90460, 90679
   3. 90471, 90678
   4. 96380, 90381