A respiratory illness such as RSV (Respiratory Syncytial Virus) can have vastly different effects on infants and children. Most children and adults may experience a cold-like illness. Some babies may experience a more severe illness requiring hospitalization.
CDC recommends babies younger than 8 months of age be protected from severe RSV by one of two options:
- A maternal RSV vaccine (Abrysvo) given to the mother during weeks 32-36 of pregnancy by her obstetrician
- An RSV antibody (Beyfortus) given to a baby whose mother did not receive the RSV vaccine during pregnancy.
- Most babies do not need both.
Beyfortus (Nirsevimab) can be given to babies and some young children. Given during a baby’s first RSV season, this antibody provides immediate protection against RSV that may last 5 months.
Some children 8-19 months of age who are at increased risk of RSV disease may receive Beyfortus during their second RSV season. These include children with chronic lung disease of prematurity, cystic fibrosis and severely immunecompromised children. For additional clinical information click on the link below to refer to current guidelines:
- CDC guidelines for pregnant moms
- CDC guidelines for babies
- American Academy of Pediatrics guidelines
AVAILABILITY
Our practice is planning to offer the RSV antibody (Beyfortus) this year for babies. The RSV antibody (Beyfortus) is recommended for all babies younger than 8 months of age during their first RSV season or within 1 week after birth if born during October to March in most of the U.S. and some vulnerable children during their second RSV season.
INSURANCE INFORMATION
We would like to share some important details for parents when considering Beyfortus.
Many private health insurance plans cover nirsevimab (Beyfortus), but there may be a cost to you depending on your plan. Contact your insurer to find out if Beyfortus will be covered for your baby.
Here are the details you will need to know when you contact your insurance company:
- The billing Procedure code (CPT) for Beyfortus injection – 90380
- The Administration code (CPT) – 96380
- The diagnosis code (ICD 10) – z29.11
If your insurance covers the injection, we will submit the claim to them on your behalf. However, if your insurance plan determines the injection is a not covered under your health plan, we will offer you a discounted price of $600 for the Beyfortus injection as a self pay option.
SCHEDULING
To schedule an appointment for an RSV shot for your baby, please call our office at (732) 741-5600.