MedicaidCoverageHigh impact
Special Provider Bulletin - Synagis® Vaccine Benefit (B2500529 - 09/2025)
Colorado Medicaid·CO · Pediatrics, Family Medicine·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 20, 2026
Summary
Colorado Medicaid updated RSV prevention coverage to prioritize new long-acting monoclonal antibodies (nirsevimab and clesrovimab) over Synagis for infants, with specific billing codes and administration requirements. Synagis manufacturer plans to discontinue the product at end of 2025.
Action Required
By October 1, 2025: Billing team must update systems to use CPT codes 90380/90381 for nirsevimab and 90382 for clesrovimab with administration codes 96380/96381. Stop using immunization administration codes 90461-90462 or 90471-90472 for these injections. Providers must enroll in VFC program to receive reimbursement. Update prior authorization processes through Prime Therapeutics for pharmacy benefit or Atrezzo portal for medical benefit.