Date: August 17, 2026
Attention: All Providers
Effective date: July 1, 2025
Call to action: Effective for dates of service on or after July 1, 2025, respiratory syncytial virus (RSV) monoclonal antibody procedure code 90382 will be updated to process as “informational only.” The administration fee may be reimbursed when submitted with RSV monoclonal antibody administration procedure codes 96380 and 96381.
RSV monoclonal antibodies nirsevimab (procedure codes 90380 and 90381), and clesrovimab (procedure code 90382) are available through the Texas Vaccines for Children (TVFC) program. Texas Medicaid will not reimburse claims for vaccines for patients who are birth through 18 years of age that are available through TVFC and administered at a site that is eligible for TVFC enrollment. The claims for these vaccines will be processed in the Medicaid Management Information System (MMIS) as informational details.
The Advisory Committee on Immunization Practices (ACIP) reviews the composition of RSV vaccines and vaccine products annually and frequently makes updates to their recommendations. Providers should refer to the Centers for Disease Control and Prevention (CDC) website for current recommendations.
Claims Reprocessing
The Texas Medicaid & Healthcare Partnership (TMHP) will reprocess any affected claims with dates of service from July 1, 2025, through August 1, 2026. Providers may receive additional reimbursement, which will be reflected on future Remittance and Status (R&S) Reports.
TMPPM Updates
On August 1, 2026, TMHP updated the Texas Medicaid Provider Procedures Manual (TMPPM)to differentiate between RSV vaccine procedure and administration codes and RSV monoclonal antibody procedure and administration codes.
The following updates were made to the TMPPM, Children’s Services Handbook, section 4.5.5, “Respiratory Syncytial Virus (RSV)”:
- RSV monoclonal antibodies (nirsevimab, procedure codes 90380 and 90381) may be administered to patients who are birth through 19 months of age and are limited to two per lifetime.
- RSV monoclonal antibodies (clesrovimab, procedure code 90382) may be administered to patients who are birth through 7 months of age and are limited to one per lifetime.
- Procedure codes 96380 and 96381 must be used in conjunction with one of the monoclonal antibodies procedure codes (90380, 90381, or 90382) for reimbursement for monoclonal antibody administration.
The following updates were made to the TMPPM, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, section 9.2.39, “Respiratory Syncytial Virus (RSV)”:
- RSV vaccine (procedure codes 90679 and 90683) may be reimbursed for patients who are 50 years of age or older.
- RSV monoclonal antibodies (clesrovimab, procedure code 90382) may be administered to patients who are birth through 7 months of age and are limited to two per lifetime.
- RSV monoclonal antibodies (nirsevimab, procedure codes 90380 and 90381) may be administered to patients who are birth through 19 months of age and are limited to one per lifetime.
Next step for providers: Providers should share this information with their staff.
If you have any questions, please email Provider Relations at providerrelations@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts
