$28.38–$31.18
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.
On this page
CMS RVU26D · Effective 2026-10-01
96381 RSV antibody Medicare reimbursement rates in Pennsylvania
Report for intramuscular administration of an RSV monoclonal antibody when physician or qualified health professional counseling is not part of the administration service. Compare 96381 office and facility rates across CMS payment localities in Pennsylvania.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 96381 in Pennsylvania?
Pennsylvania has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$22.86–$25.30
2 of 2 localities have a supported rate.
Facility setting
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Drug administration
About 96381: RSV monoclonal antibody administration without counseling
Report for intramuscular administration of an RSV monoclonal antibody when physician or qualified health professional counseling is not part of the administration service.
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.
Where the value comes from
- Work RVU0.17 · 23%
- Practice expense (office) RVU0.55 · 75%
- Malpractice RVU0.01 · 1%
548
Medicare services in 2024 · #3474 by national volume
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.
96381 compared with similar codes
Office rates for Pennsylvania, from the same CMS release.
$14.58–$15.91
96372 is the general injection service for therapeutic, prophylactic, or diagnostic drugs. 96381 specifically identifies intramuscular administration of an RSV monoclonal antibody without counseling.
$20.71–$22.87
90471 is for vaccine administration. 96381 is used for an RSV monoclonal antibody, which is a preventive biologic rather than a vaccine.
Compare 96381 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
2 of 2 payment localities
Metropolitan Philadelphia →
Office / nonfacility
$25.30
Facility
Unavailable
Rest Of Pennsylvania →
Office / nonfacility
$22.86
Facility
Unavailable
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96381 billing questions
When should 96381 be chosen instead of 96380?
Use 96381 when physician or qualified health care professional counseling is not included with the RSV monoclonal antibody administration. Use 96380 when that counseling is provided.
Is the RSV monoclonal antibody product included in 96381?
No. 96381 describes administration; report the product separately when it is separately reportable.
Can 96381 be reported for an RSV vaccine?
No. This code is for administration of an RSV monoclonal antibody, not an RSV vaccine. Vaccine administration is reported using the applicable immunization administration code.
Is 96381 reported by time or by the number of minutes?
No. It describes an intramuscular administration service, not a timed infusion. Documentation should identify the administered product, route, site, and counseling status.
What documentation supports 96381?
Document the RSV monoclonal antibody administered, dose, intramuscular route, injection site, date, and that physician or qualified health care professional counseling was not part of the administration.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,79196377,,Applicaton on-body injector,A,,0.17,0.39,,0.39,NA,0.01,0.57,0.57,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79296379,,Unl ther/prop/diag inj/inf,C,,0.00,0.00,,0.00,,0.00,0.00,0.00,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79396380,,Admn rsv monoc antb im cnsl,A,,0.28,0.60,,0.60,NA,0.02,0.90,0.90,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79496381,,Admn rsv monoc antb im njx,A,,0.17,0.55,,0.55,NA,0.01,0.73,0.73,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79596401,,Chemo anti-neopl sq/im,A,,0.21,1.90,,1.90,NA,0.04,2.15,2.15,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79696402,,Chemo hormon antineopl sq/im,A,,0.19,0.95,,0.95,NA,0.02,1.16,1.16,5,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,79796405,,Chemo intralesional up to 7,A,,0.52,1.98,,0.16,,0.03,2.53,0.71,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00