MedicaidPrior AuthMedium impact
Special Provider Bulletin - Synagis® Vaccine Benefit (B2300500 - 10/2023)
Colorado Medicaid·CO · Pediatrics, Family Medicine·Pharmacy
Effective date
Oct 1, 2023
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) updated Synagis vaccine coverage for the 2023-2024 RSV season, starting October 1, 2023 through April 1, 2024. Prior authorization is required for all Synagis administration with a maximum of 5 doses per season, billed through either pharmacy benefit (home/long-term care) or medical benefit (office/hospital) depending on administration location.
Action Required
Immediately for Colorado Medicaid providers: Submit prior authorization requests for Synagis through Magellan Rx Management (pharmacy benefit) or Acentra Health via Atrezzo portal (medical benefit) before administration. Use CPT code 90378 for medical benefit billing, calculating units based on 50-mg dosages. Ensure all pharmacy PARs are signed by prescribing physician. Maximum 5 doses per season with minimum 26-day intervals between injections.