Hospitals

Codes Requiring Service Authorization spreadsheet has been updated

The following drugs have been added and will require service authorization for dates of service on or after April 1, 2024.

UPDATED ICD-10-CM Coding Guidance - Administering Abrysvo™ (CPT 90678) to Pregnant Individuals

CDC recommends one dose of Pfizer’s bivalent RSVpreF vaccine (Abrysvo) during RSV season for people who are 32 through 36 weeks pregnant. For claims to correctly adjudicate for this population of ND Medicaid members, an ICD-10-CM code specific to the third trimester of pregnancy AND an ICD-10-CM code from the Z3A.32 - Z3A.36 range must be present on the claim and pointed to the specific line that 90678 is billed on.