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Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 09-2025-10)
Effective date
Not stated in the notice
Identified
Aug 13, 2026
Summary
Aetna's commercial policy for Enflonsia (clesrovimab-cfor), CPB 1088, covers one intramuscular dose to prevent RSV lower respiratory disease in infants under 8 months entering their first RSV season, when the source's criteria are met. Those criteria turn on maternal RSV vaccine status and whether the infant has already received clesrovimab, nirsevimab or palivizumab, and commercial plans may require a trial of a lower-cost preferred drug first.
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What to do
Action · 6 steps
01No effective date is stated in the source, so confirm the current status with Aetna before relying on this policy.
02REQUIREMENTS: Providers and front desk staff, before giving an infant a clesrovimab dose, document whether maternal RSV vaccine was received and how many days before birth, whether the mother had a prior pregnancy with the vaccine, and whether the infant has already had clesrovimab, nirsevimab or palivizumab.
03Providers, for commercial members, check the Aetna Commercial Clinical Program Summary for the preferred drug list, since a trial of a preferred lower-cost drug may be required before this product is covered.
04Billing team, in charge entry, bill the drug with CPT 90382 and the administration with CPT 96380 or 96381, and attach the criteria documentation to the chart.
05Billing team, use diagnosis codes that support the criteria, such as Z29.11 for prophylactic RSV immunotherapy, and list any qualifying conditions the source names (for example B20, Z95.1, Z99.81) only when the chart supports them.
06For infants who had cardiopulmonary bypass or ECMO, providers may give an additional dose once the infant is stable, so document it as a second dose on the claim.
Codes mentioned
9038290380903819067890679963729638096381B20B97.4Z29.11Z95.1Z99.81
Original notice
Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 09-2025-10)
aetna.com · Always check the source before changing claims.
Related changes
See all Aetna changes →Clesrovimab-cfor (Enflonsia) (CPB 1088, reviewed 2026-10-09)MediumEffective Oct 9, 2025 · Medical PolicyNirsevimab-alip (Beyfortus) (CPB 1038, reviewed 2026-10-09)MediumEffective Sep 12, 2023 · Medical PolicyNirsevimab-alip (Beyfortus) (CPB 1038, reviewed 2025-10-09)MediumNo effective date · Medical PolicyRespiratory Syncytial Virus (RSV) Vaccines for Adult and Maternal Use (CPB 1027, reviewed 2026-10-09)MediumEffective Apr 11, 2023 · Medical PolicyBrowse every Aetna change in the policy list