CMS updates COVID-19 vaccine prices for 2024-2025 season
CMS recently updated prices for certain Novavax, Pfizer-BioNTech, and Moderna COVID-19 vaccines for the 2024-2025 season.
The agency updated pricing for the following Current Procedural Terminology (CPT ®) codes used to report various COVID-19 vaccines:
- 91304: $161.538
- 91318: $65.550
- 91319: $87.780
- 91320: $155.895
- 91321: $147.060
- 91322: $161.652
There is no change to the payment allowances for CPT codes 91318 and 91319 from last year. Organizations are to use CPT code 90480 to bill for the administration of the vaccine.
CMS released the 2024-2025 prices after the FDA granted emergency use authorization for the new mRNA and Novavax COVID-19 vaccines last month. The updated formulas are designed to target the JN.1 and KP.2 strains of the Omicron variant of SARS-CoV-2.
Revenue integrity professionals can view CMS’ vaccine pricing web page for more details on the 2024-2025 prices. Find more information on COVID-19 vaccine billing and coding in CMS’ COVID-19 Vaccine Toolkit.
Editor's note: Find more NAHRI resources on COVID-19 vaccines and treatments here.