MedicaidPrior AuthMedium impact
Special Provider Bulletin - Synagis® Vaccine Benefit (B2200486 - 11/2022)
Colorado Medicaid·CO · Pediatrics, Pulmonology, Cardiology·Pharmacy
Effective date
Oct 4, 2022
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) updated Synagis vaccine prior authorization requirements for the 2022-2023 RSV season, which runs from October 4, 2022 to April 28, 2023. The policy specifies different PAR submission processes for pharmacy benefit (home/long-term care administration) versus medical benefit (office/hospital administration), with a maximum of 5 doses allowed per season.
Action Required
Immediately: For Colorado Medicaid Synagis administration, billing team must ensure proper PAR submission - use Magellan Rx Management for home/long-term care facility administration (pharmacy benefit) or submit to KEPRO through Atrezzo portal for office/hospital administration (medical benefit). Use CPT code 90378 for medical benefit PARs and calculate billing units based on 50mg dosage increments. Maximum 5 doses per season allowed through April 28, 2023.