Maximum Doses of Palivizumab (Synagis®) Increased for 2022–2023 RSV Season

October 26, 2022

On October 11, 2022, California Children’s Services (CCS) issued Information Notice 22-04. The notice stated that CCS has been tracking Respiratory Syncytial Virus (RSV) infection test positivity rates in conjunction with the California Department of Public Health (CDPH), which receives RSV test positivity data from regional sentinel laboratories across California. From these data, CDPH prepares aggregated statewide RSV test positivity reports. These reports, together with those of the National Respiratory and Enteric Virus Surveillance System (NREVSS), indicate a pattern of test positivity rates suggesting a relatively earlier start to the RSV season than in typical years, such as 2019 through 2020.

Therefore. effective for dates of services on or after October 1, 2022 and continuing for the 2022–2023 Respiratory Syncytial Virus (RSV) season only, the Department of Health Care Services (DHCS) is updating the policy of Palivizumab (CPT® code 90378 [respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each]) to allow up to six doses based on current data of RSV infection test positivity rates in California.

For the current apparent RSV season only (2022–2023), more than five doses of Palivizumab may be administered; providers may administer up to a maximum of six doses per child if the child receives the first dose in October. Monthly doses from October through April will provide protection through May. A Treatment Authorization Request (TAR) must be submitted justifying medical necessity based on the TAR criteria published in the Medi-Cal provider manual.

Updated provider manual sections will be released in a future Medi-Cal Update.