AMA streamlines COVID-19 vaccine codes

The American Medical Association (AMA) CPT® Editorial Panel recently approved the consolidation of more than 50 codes used to report COVID-19 vaccines. In addition, the AMA approved the following new vaccine product codes:

• Pfizer
  
  • 91318: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use (6 months through 4 years)
  • 91319: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use (5 years through 11 years)
  • 91320: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use (12 years and older)
• Moderna
  
  • 91321: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use (6 months through 11 years)
  • 91322: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use (12 years and older)

Administration code 90480 should be reported along with these codes. Further information on these additions, as well as the deleted and retained codes, can be found in the latest edition of CPT® Assistant.

After some providers reported an increase in denials for COVID-19 vaccines, Xavier Becerra, secretary of HHS, addressed their concerns in a recent letter to the healthcare payer community.

CMS previously reminded payers that the requirement for most plans and issuers to cover updated Pfizer and Moderna COVID-19 vaccines without cost-sharing became effective immediately upon FDA authorization, according to Becerra. The FDA authorized the updated monovalent vaccines on September 11.

Becerra also touched on changes after the COVID-19 PHE. “If a plan or issuer does not have a provider in its network who can provide a qualifying [COVID-19} preventive service, the plan or issuer must cover the item or service when furnished by an out-of-network provider and may not impose cost sharing with respect to the item or service,” he wrote.

Revenue integrity professionals must ensure their organization is properly coding and billing for COVID-19 vaccines. To do so, view the AMA’s resource to find the appropriate CPT code combination for type and dose of vaccine. Additional information can be found in CMS’ COVID-19 Provider Toolkit.

Editor's note: Find more NAHRI resources on COVID-19 vaccines here.