Billing code 96381: RSV antibodyMedicare rate & RVUs

Medicare pays $24.38 for 96381 nationally in the office. Local office rates run $21.63–$32.97.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 96381 covers

This service covers an intramuscular injection of a monoclonal antibody intended to prevent respiratory syncytial virus disease, commonly for an infant or young child receiving seasonal protection. Pediatricians, family physicians, nurses, and other qualified staff may administer the dose in an office or outpatient clinic. Nirsevimab is a familiar example of an RSV preventive antibody; this is an administration service, not treatment of an active RSV infection.

Choose this code when the administration does not include counseling by a physician or other qualified health care professional; use 96380 when that counseling is provided. Document the product, dose, route, administration site, date, and whether counseling occurred. Report the product separately when it is separately reportable. This is an administration service rather than a timed infusion, so the documentation should support the injection performed and the code selection.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 96381 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

96381 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 96381 rate is calculated

Each of 96381’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 96381

96381 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

96381 compared with similar codes

How to choose

96380RSV antibody administration

Both describe intramuscular RSV monoclonal antibody administration. Choose 96380 when physician or qualified health care professional counseling is provided; choose 96381 when it is not.

96372SC/IM injection

96372 is the general injection service for therapeutic, prophylactic, or diagnostic drugs. 96381 specifically identifies intramuscular administration of an RSV monoclonal antibody without counseling.

90471Immunization administration

90471 is for vaccine administration. 96381 is used for an RSV monoclonal antibody, which is a preventive biologic rather than a vaccine.

Codes related to 96381

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates