Maximum Doses of Palivizumab Increased for 2021–2022 RSV Season

August 31, 2021

Effective for dates of services on or after August 19, 2021 and continuing for the 2021–2022 respiratory syncytial virus (RSV) season only, a Treatment Authorization Request(TAR) for additional doses of Palivizumab (CPT® code 90378 [respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each]) outside of a normal RSV season should be accompanied by county RSV positivity data for the time period reflecting the administered dose, confirming applicable RSV PCR and/or antigen positivity rates consistent with values seen during typical past RSV seasons. Additional information regarding county RSV positivity data can be found below.

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