Updated Policy for Palivizumab for the 2021-2022 RSV Season

October 8, 2021

Effective for dates of services on or after August⊄19, 2021, and continuing for the 2021–2022 respiratory syncytial virus (RSV) season only, county RSV positivity data for the time period reflecting the administered dose of Palivizumab (CPT© code 90378 [respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each]) is no longer required to be accompanied with a Treatment Authorization Request (TAR) for doses submitted outside the time period of a typical RSV season such as 2019–2020. Additional information can be found below.
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