June 18, 2025
Certain diagnoses codes are needed to enable payment for ABRYSVO respiratory syncytial virus vaccines given to pregnant members with Blue Cross Community Health PlansSM during gestational weeks 32-36. Following is guidance from the Illinois Department of Healthcare and Family Services and instructions for submitting corrected claims for past denials with dates of service as early as Oct. 1, 2023.
Diagnoses codes: When coding ABRYSVO for pregnant members ages 19 and older, bill with one of the following diagnoses on the claim for payment:
- Z3A.32 – 32 weeks gestation of pregnancy
- Z3A.33 – 33 weeks gestation of pregnancy
- Z3A.34 – 34 weeks gestation of pregnancy
- Z3A.35 – 35 weeks gestation of pregnancy
- Z3A.36 – 36 weeks gestation of pregnancy
Medical records: We don’t require submission of medical records with the claim.
Submitting corrected claims for past denials with dates of service as early as Oct. 1, 2023: If your previous claims for ABRYSVO were denied, you may file corrected claims with the accepted diagnosis codes.
Resubmit corrected claims reflecting the accepted diagnosis codes by Sept. 18, 2025, or within 90 days from the date of this notice.
After the deadline, we’ll adjust and pay the properly coded claims, allowing a one-time override of timely filing rules.
Only claims that were originally received per timely filing requirements will be eligible for adjustment.
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This material is for educational purposes only and is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate codes based upon the medical record documentation and coding guidelines and reference materials.
The listing of any particular drug or classification of drugs is not a guarantee of benefits. The information mentioned here is for informational purposes only and is not a substitute for the independent medical judgment of a physician. Members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any medication is between the member and their health care provider.