[Ohio] Beyfortus Drug Billing Update

By May 1, 2025: Billing team must implement the following changes: (1) VFC-enrolled providers: Continue requesting Beyfortus through the VFC program and submit only CPT 96372 (administration) to CareSource; (2) Non-VFC providers: Stop submitting CPT 90380 and 90381 to CareSource and instead submit these drug codes to Gainwell SPBM (spbm.medicaid.ohio.gov), while continuing to submit CPT 96372 (administration) to CareSource; (3) Update billing software to reject or route CPT 90380 and 90381 submissions to CareSource for Ohio Medicaid claims; (4) Verify provider VFC enrollment status in system to ensure correct billing pathway. Failure to transition will result in claim denials for Beyfortus drug administration after May 1, 2025. Contact CareSource Provider Services at 1-800-488-0134 for questions.