Since the very first days of the COVID-19 pandemic, there have been a variety of CPT code changes to deal with the crisis. Now, there’s been a new update to the CPT code set by the American Medical Association regarding changes to the way that COVID-19 vaccines and booster shots — slated to begin rolling out soon — are billed. Not only do these updates include new CPT codes for the COVID-19 vaccine, but also a new code for a new Pfizer formulation of the vaccine, a formulation that moved to a tris-sucrose buffer in place of the original formulation’s phosphate buffer.
COVID-19 Vaccine Tris-sucrose Formulation Codes
The new codes for the new Pfizer tris-sucrose formulation include:
- 91308: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use; 0081A first dose, 0082A second dose, 0083A third dose
- 91305: 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, tris-sucrose formulation, for intramuscular use
- 0051A: 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, tris-sucrose formulation; first dose
- 0052A: 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, tris-sucrose formulation; second dose
- 0053A: 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, tris-sucrose formulation; the third dose
Keep in mind, these codes can be used for the Pfizer tris-sucrose formulation of the COVID-19 vaccine after it receives either full approval from the FDA or it is provided with emergency use authorization, which is likely coming soon.
The original formulation of Pfizer’s COVID-19 vaccine has already been granted full approval from the FDA, and emergency use authorization has been providing for this vaccine to include a booster shot, as well. According to news from the White House, there are plans to roll out the third — or booster — dose of Pfizer’s COVID-19 vaccine soon, and CPT code 0053A is the code that will be used to document that boost shot. Additional booster shots for other vaccines, such as Moderna, are expected to come soon, but a bit later than the Pfizer booster.
Moderna Boosters — New CPT Codes
While Moderna’s vaccine hasn’t received full approval from the FDA, the emergency use authorization from the FDA has been altered to allow a third vaccine dose of that vaccine. To prepare for those booster shots likely coming from Moderna, additional new CPT codes were announced by the American Medical Association, including:
- 91311: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 25 mcg/0.25 mL dosage, for intramuscular use; 0111A first dose, 0112A second dose
- 91306: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 50 mcg/0.25 mL dosage, for intramuscular use
- 0064A: 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, 50 mcg/0.25 mL dosage, a booster dose.
According to the AMA, the third dose of the Moderna COVID-19 vaccine is more likely to be administered at a slightly different dose from the original formulation, unlike the booster of the Pfizer vaccine. This is why the AMA released a new vaccine code for the booster vaccine from Moderna. Of course, these booster CPT codes are provisional codes that will only be effective once the FDA has granted authorization or approval.
Along with the previous CPT codes, additional new CPT codes included in this new release include the following:
- 0004A: 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; booster dose
- 0054A: 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, tris-sucrose formulation; booster dose
The Novavax vaccine joins Moderna and Pfizer COVID vaccines. While this vaccine is still pending approval by the EUA, the AMA has been assigned the following Category 1 CPT code and long descriptor:
- 91304: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative-free, 5 mcg/0.5 mL dosage, for intramuscular use
For longer descriptors of all the new CPT codes provided by the AMA, you can visit their website for additional information.
Billing and coding for COVID-19-related services continue to change regularly, so it’s important to stay current on the latest news. If your practice is struggling to keep up with all the changes while managing your practice in a continuing pandemic, M-Scribe.com can help. We offer professional billing and coding services that help practices like yours boost revenue and avoid denials, giving you the ability to focus on what you do best — helping people. Contact M-Scribe.com today to find out how we can help your practice.
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