MedicaidPrior AuthMedium impact
Special Provider Bulletin - Synagis® Vaccine Benefit (B2400513 - 10/2024)
Colorado Medicaid·CO · Pediatrics, Family Medicine·Pharmacy
Effective date
Oct 1, 2024
We identified it
Jun 20, 2026
Summary
Colorado Medicaid updated RSV prevention policy prioritizing nirsevimab over Synagis vaccine for children under 2. New CPT codes 90380/90381 must be used for nirsevimab claims, and the 2024-2025 Synagis season runs October 1, 2024 through April 1, 2025 with prior authorization required.
Action Required
Immediately: Update billing system to use CPT codes 90380/90381 for nirsevimab administration instead of immunization codes 90461-90462 or 90471-90472. Billing team must obtain prior authorization for all Synagis requests through Prime Therapeutics (pharmacy benefit) or Atrezzo portal (medical benefit). Providers must enroll in VFC program for Colorado Medicaid reimbursement.