Preventive Coverage Expansion of Respiratory Syncytial Virus Vaccine for Commercial Members (Retroactively Effective June 12, 2025)

By September 26, 2025 (one month after policy posting): Billing team must update billing system to classify RSV vaccine administration and vaccine codes as preventive services (with $0 cost-sharing) for all commercial plan members. Verify patient eligibility for preventive coverage before billing. Reprocess any RSV vaccine claims from June 12, 2025 forward that were incorrectly billed as non-preventive or required patient cost-sharing. Add RSV vaccine to preventive service lists in billing software and encounter forms. Clinical staff should verify patient age/eligibility criteria per vaccine guidelines. Failure to apply preventive pricing retroactively may result in billing corrections and patient refunds.