RSV Vaccine Services Procedure Code 90382 to Be Updated as Informational Effective July 1, 2025

REQUIREMENTS: By June 30, 2025: Billing team must update Texas Medicaid billing system to process CPT 90382 (clesrovimab) as informational only for dates of service on or after July 1, 2025. Configure system to: - Submit CPT 90382 with administration codes CPT 96380 or 96381 for reimbursement eligibility - Flag claims for RSV vaccines (90679, 90683) and monoclonal antibodies (90380, 90381, 90382) administered at TVFC-eligible sites to pediatric clients (birth-18 years) for denial/informational processing - Apply age and lifetime limit restrictions per updated TMPPM guidelines (90382: birth-7 months, one per lifetime; 90380/90381: birth-19 months, two per lifetime) Immediate action: Verify practice TVFC enrollment status with Texas Vaccines for Children program. If enrolled, coordinate with clinical staff on vaccination site eligibility to ensure compliant billing. Before July 1, 2025: Provider and clinical staff must review updated RSV administration guidelines on CDC website and be familiar with new age/limit restrictions per ACIP recommendations. Update encounter forms and EMR templates to capture RSV product type (vaccine vs. monoclonal antibody) and client age at time of administration. Through August 1, 2026: Monitor Remittance and Status (R&S) reports for reprocessed claims with corrected reimbursement. Flag any discrepancies for follow-up with TMHP Contact Center (800-925-9126). Consequence of inaction: Claims for RSV services will be denied or processed incorrectly; practices may lose reimbursement for eligible administration fees and miss reprocessing opportunities.