CMS updates payment allowance and billing instructions for new Novavax COVID-19 vaccine

Wednesday, October 18, 2023

CMS recently updated the national payment allowance and provided billing instructions for the new Novavax COVID-19 vaccine, authorized for patients 12 years and older.

The agency updated the national payment allowance for Current Procedural Terminology (CPT©) code 91304, which is used to report the new Novavax vaccine, to $148.20. In addition, it will no longer pay for CPT codes 0041A, 0042A, and 0044A. Providers should report CPT code 90480 to bill for the administration of the vaccine.

CMS released this information after the FDA amended the vaccine’s emergency use authorization on October 3.

CMS noted that the federal government is not purchasing these products. “Medicare Part B pays for the drug and its administration under the applicable Medicare Part B payment policy,” said the agency.

This update follows recent efforts by the American Medical Association (AMA) to streamline COVID-19 vaccine codes. The AMA consolidated more than 50 existing codes and added five product codes for new Pfizer and Moderna mRNA COVID-19 vaccines.

All of these updates became effective on October 3. Revenue integrity professionals must ensure their organization is properly coding and billing for COVID-19 vaccines. View the AMA’s resource to find the appropriate CPT code combination for type and dose of vaccine. Providers can find additional information in CMS’ COVID-19 Provider Toolkit.

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