MedicaidPrior AuthMedium impact
Special Provider Bulletin - Synagis® Vaccine Benefit (B2200484 - 10/2022)
Colorado Medicaid·CO · Pediatrics, Pulmonology, Cardiology·Pharmacy
Effective date
Oct 4, 2022
We identified it
Jun 20, 2026
Summary
Colorado Medicaid (Health First Colorado) has updated its Synagis vaccine policy for the 2022-2023 RSV season, starting October 4, 2022, with an earlier season start due to atypical RSV activity. Prior authorization is required for all Synagis administration, with specific submission processes for home vs. office/facility administration.
Action Required
Immediately: For Colorado Medicaid patients needing Synagis, billing team must obtain prior authorization through appropriate channels - submit to KEPRO via Atrezzo portal for office/facility administration using CPT 90378, or to Magellan for home administration. Update billing system to flag Synagis claims for prior auth requirement. Note that only 50mg vials (NDC 60574-4114-01) are covered this season, and 100mg vial CPT codes are no longer accepted.