Beyfortus (RSV Preventative Antibody)

Infants born between April 2025 thru March 2026 may qualify for the antibody after 10/1/2025.

 Those less than 22 months with a history of prematurity, or other severe chronic conditions may also qualify. 

1. Please contact your insurance company using the member services number listed on your ID card. You must obtain a reference number for your call.
    
2. Beyfortus is not considered a vaccine; it is a preventative antibody and is therefore processed differently than other vaccines. While coverage has improved compared to last year, some insurance plans still require prior authorization.
    
3. When speaking with the representative, ask if Beyfortus is a covered benefit under your plan. If they request a CPT code, provide:
    
   • 90380 if your infant weighs less than 5 kg (approximately 11.5 lbs)
      
   • 90381 if your infant weighs more than 5 kg
      

1. If Beyfortus is covered, also ask if you have met your deductible and what your expected copay or coinsurance will be. Some families may have no out-of-pocket cost, while others may be responsible for the full amount of $625.
    
2. After your call, please send us a portal message with your reference number and the expected deductible/copay amount. This amount will be due at the time of your appointment.
    
3. Once we receive your message, we will verify eligibility. This process may take up to 48 business hours, after which your infant’s appointment will be scheduled.