Updates on COVID-19 Vaccine Codes

CMS and the American Medical Association (AMA) collaborated to finalize a new approach to report the use of COVID-19 vaccines. The new coding structure establishes a range of codes, starting with code 91300, specifically for COVID-19 vaccine products, which will be effective upon receiving FDA’s Emergency Use Authorization or approval. These codes are indicated with the 🗲 symbol and will be tracked by the AMA to monitor their FDA-approval status. Once the FDA status changes to approved, the 🗲 symbol will be removed from the codes. Since the federal government will be responsible for initially purchasing and distributing the vaccines to health care entities across the country, the administration codes will be vital in specifying which dose (e.g., first dose or second dose) of a specific COVID-19 vaccine was administered.

Appendix Q: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) Vaccines

A new Appendix Q has been added to the CPT code set to accommodate the new coding structure. In Appendix Q, a vaccine product and its administration code(s) are listed. Also, the vaccine product’s specific dosing timeline (interval) and its manufacturer are recorded. Appendix Q will be broadly utilized in most health care delivery settings, not only to confirm proper code selection for the vaccine products and their administrations but also to ensure that the patients receive the correct dose of the same vaccine product in a multidose regimen. For example, if a vaccine code in Appendix Q has two associated administration codes, this will assist the health care professional in selecting the appropriate administration code for the multidose vaccine product.

This table links the individual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine product codes (91300, 91301, 91302, 91303) to their associated immunization administration codes (0001A, 0002A, 0011A, 0012A, 0021A, 0022A, 0031A), manufacturer name, vaccine name(s), 10 and 11-digit National Drug Code (NDC) Labeler Product ID, and interval between doses.

Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration During the Public Health Emergency: (DOS = Date of Service, TBD = To Be Determined)

Vaccine Code Vaccine Code Descriptor Vaccine Administration Code(s) Vaccine Manufacturer Vaccine Name(s) NDC 10/NDC 11 Labeler Product ID (Vial) Dosing Interval
91300 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use “0001A (1st dose) 0002A (2nd dose)” Pfizer, Inc Pfizer-BioNTech COVID-19 Vaccine “59267-1000-1 59267-1000-01” 21 days
91301 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use “0011A (1st dose) 0012A (2nd dose)” Moderna, Inc Moderna COVID-19 Vaccine 80777-273-10 80777-0273-10 28 days
91302 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use “0021A (1st Dose) 0022A (2nd Dose)” AstraZeneca, Plc AstraZeneca COVID-19 Vaccine 0310-1222-10 00310-1222-10 28 Days
91303 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use 0031A (Single dose) Janssen Janssen COVID-19 Vaccine 59676-580-05 59676-0580-05 Not applicable

Medicare Part B Payment for COVID-19 Vaccines during the Public Health Emergency

CMS has released a set of toolkits for providers, states, and insurers to help the health care system prepare and swiftly administer these products once they become available.  These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries.  This webpage provides the payment allowances and other related information for these products.  For more information, review the COVID-19 provider toolkit.

Payment Allowances and Effective Dates for COVID-19 Vaccines and their Administration During the Public Health Emergency: (DOS = Date of Service, TBD = To Be Determined)

CPT Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name National Payment Allowance Effective for Claims with DOS on or after 03/15/2021 National Payment Allowance Effective for Claims with DOS through 03/14/2021 Effective Dates
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer Pfizer-Biontech Covid-19 Vaccine $0.010* $0.010* 12/11/2020 – TBD
0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – First Dose $40.000** $16.940** 12/11/2020 – TBD
0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose $40.000** $28.390** 12/11/2020 – TBD
91301 SARSCOV2 VAC 100MCG/0.5ML IM Moderna Moderna Covid-19 Vaccine $0.010* $0.010* 12/18/2020 – TBD
0011A ADM SARSCOV2 100MCG/0.5ML1ST Moderna Moderna Covid-19 Vaccine Administration – First Dose $40.000** $16.940** 12/18/2020 – TBD
0012A ADM SARSCOV2 100MCG/0.5ML2ND Moderna Moderna Covid-19 Vaccine Administration – Second Dose $40.000** $28.390** 12/18/2020 – TBD
91302 SARSCOV2 VAC 5X10^10VP/.5MLIM AstraZeneca AstraZeneca Covid-19 Vaccine $0.010* $0.010* xx/xx/xxxx – TBD
0021A ADM SARSCOV2 5X10^10VP/.5ML 1 AstraZeneca AstraZeneca Covid-19 Vaccine Administration – First Dose $40.000** $16.940** xx/xx/xxxx – TBD
0022A ADM SARSCOV2 5X10^10VP/.5ML 2 AstraZeneca AstraZeneca Covid-19 Vaccine Administration – Second Dose $40.000** $28.390** xx/xx/xxxx – TBD
91303 SARSCOV2 VAC AD26 .5ML IM Janssen Janssen Covid-19 Vaccine*** $0.010* $0.010* 02/27/2021 – TBD
0031A ADM SARSCOV2 VAC AD26 .5ML Janssen Janssen Covid-19 Vaccine Administration*** $40.000** $28.390** 02/27/2021 – TBD

* Since we anticipate that providers, initially, will not incur a cost for the product, CMS will update the payment allowance at a later date.  Providers should not bill for the product if they received it for free.

** These rates will also be geographically adjusted for many providers. For providers and suppliers with payments geographically adjusted by the methodology used by the Medicare Physician Fee Schedule (MPFS), files with the geographically adjusted payment rates for COVID-19 vaccine administration are included in the “Additional Resources” section below. Certain settings utilize other payment methodologies, such as payment based on reasonable costs.

*** Johnson & Johnson COVID-19 Vaccine

To assist CPT code users in differentiating and appropriately reporting the available vaccine product codes and their affiliated immunization administration codes, the American Medical Association (AMA) established a website that features timely updates of the CPT Editorial Panel actions.

https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes

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References:

  • AMA CPT Assistant: Severe acute respiratory syndrome coronavirus (SARS-CoV-2), 01/19/21 January update
  • AMA CPT Assistant: Severe acute respiratory syndrome coronavirus (SARS-CoV-2), 12/17/20 December update
  • AMA CPT Assistant: Vaccine coding development, 11/11/20

  • Posted by David Berkowitz
  • On April 23, 2021
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