AMA releases new CPT codes for COVID-19 vaccines

Wednesday, November 18, 2020

The American Medical Association (AMA) recently announced a handful of new CPT® codes for reporting COVID-19 vaccine products and immunization administration.

The code release includes two vaccine product codes and four vaccine administration codes, Revenue Cycle Advisor reported. These new CPT codes will allow healthcare providers to report and track the administration of these COVID-19 vaccines once they receive approval or an emergency use authorization from the FDA. The codes will go into effect at that time.

The vaccine codes are linked to products manufactured by Pfizer, Inc. and Moderna, Inc. They are:

  • 91300, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use
    • Vaccine manufacturer: Pfizer Inc.
  • 91301, SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage, for intramuscular use
    • Vaccine manufacturer: Moderna Inc.

Each vaccine product code is linked with a pair of vaccine administration codes, which correspond to first and second doses.

For the 91300 product code, providers would report:

  • 0001A, immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; first dose
  • 0002A, …; second dose

For the 91301 product code, providers would report:

  • 0011A, immunization administration by intramuscular injection of SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; first dose
  • 0012A, …; second dose

The AMA released the codes prior to public availability of the vaccines to allow organizations to update their systems. Revenue integrity professionals should ensure that their systems are updated with the new codes accordingly and staff are educated as necessary.

In it’s Fourth COVID-19 Interim Final Rule with Comment Period (IFC-4), CMS finalized billing and reimbursement guidance for any potential COVID-19 vaccines. COVID-19 vaccines will be added to the list of preventive vaccines that are covered under Medicare Part B without coinsurance or deductible. IFC-4 also requires non-grandfathered private health plans to cover COVID-19 vaccines without beneficiary cost sharing. The agency will establish interim payment rates and APC assignments outside of the rulemaking process and expects to base billing processes on those already in place for influenza vaccines.

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