Big changes will streamline CPT coding for immunization

. 5 MIN READ
By
Andis Robeznieks , Senior News Writer

Significant changes in the Current Procedural Terminology (CPT®) code set for immunizations reflect the changing nature of how COVID-19 is being addressed as actions transition from a public health emergency response to combatting emerging variants much like the flu.

One significant change involves the consolidation of more than 50 previous codes to streamline reporting of immunizations for COVID-19. A new vaccine-administration code, 90480, was approved for reporting the administration of any COVID-19 vaccine for any patient. This replaces all previously approved, product-specific vaccine-administration codes.

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From a public health perspective, there was great initial value in tracking each individual vaccine during the public health emergency, With the end of the public health emergency, there is no longer a need for the coding granularity of individual administration codes for every vaccine product. 

Additionally, the Vaccines and Related Biological Products Advisory Committee (VRBPAC), an advisory group of the FDA, recommended that the COVID-19 vaccine for the 2023–2024 vaccination season be a monovalent vaccine that contains the XBB.1.5 strain, and noted that a number of COVID-19 vaccine products will no longer be recommended for use. The streamlined structure brings greater alignment between CPT and the current COVID-19 vaccine reporting environment.

“The new coding system will allow for new vaccines for new variants whenever they come up without having to do a new code,” said Samuel “Le” Church, MD, MPH, a member of the CPT Editorial Panel and vice-chair of its Immunization Coding Caucus.

Dr. Church, president of the Georgia Academy of Family Physicians, spoke at the annual AMA CPT and RBRVS Annual Symposium, held virtually this year.

The CPT Editorial Panel approved five new COVID-19 vaccine product codes and one administration code in August 2023. These new COVID-19 codes replaced all previously approved specific COVID-19 product and administration codes, except for vaccine product code 91304 for the Novavax vaccine.

Specific information to assist with proper code selection of the more than 50 COVID-related vaccine product and administration codes were contained in Appendix Q of the CPT code set. With the removal of those COVID-19 codes, Appendix Q was also deleted in November.

Some vaccine and immune globulin products are assigned a code in anticipation of eventual approval by the Food and Drug Administration. These codes are marked with a lightning bolt symbol in the Category I Immunization code descriptors (PDF).

The new codes added for 2024 include three Pfizer-product codes and reflect vaccine concentrations developed for different age groups:

  • 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  in patients 6 months–4 years old.
  • 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 in patients 5–11 years old.
  • 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 in patients 12 years and older.

There are also two new Moderna-product codes: 

  • 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 in patients 6 months–11 years old.
  • 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 was associated for use in patients 12 years or older.

“My hope is that all these changes will dramatically simplify your coding experience when dealing with the COVID-vaccine products,” Dr. Church said.

Learn more with the AMA about the most current COVID-19 CPT vaccine and immunization codes.

Codes for all immunization products

Typically, vaccine codes are electronically published July 1 and January 1, though some may require expedited release due to public health concerns as was the case with the vaccines for COVID-19 and respiratory syncytial virus (RSV).

“After the final approval is done, then that lightning bolt will be taken away,” Dr. Church said.

Reflecting all these developments, the CPT “vaccine early release schedule” will now be known as the “immunization early release” schedule and will include vaccines/toxoids, immune globulins and serum or recombinant products.

“There are a lot of changes that are happening in the world of immunization, so it was a bit restrictive to have it be a ‘vaccine’ early release policy, so we expanded that,” Dr. Church explained.

“We’ve got a lot going on in the RSV world,” he added.

This includes two new seasonal RSV monoclonal antibody immunization pediatric codes for children less than 24 months of age with dosage based on the child’s weight, as well as two new administration codes for these products that are differentiated by the inclusion of counseling:

  • 90380: Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use.
  • 90381: Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use.
  • 96380: Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional.
  • 96381: Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection.

Additionally, three vaccine codes were created and associated with use in the adult population:

  • 90678: Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use  is associated with adults 60 years and older, plus pregnant patients at 32–36 weeks gestation.
  • 90679: Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use is associated with use in adults 60 years and older.
  • 90683: Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use is an mRNA product associated with use in adults 60 years and older.

These codes were developed to provide better tracking to support data-driven planning and allocation, and to track patient outcomes.

Also new are:

  • 90589: Chikungunya virus vaccine, live attenuated, for intramuscular use.
  • 90623: Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y- tetanus toxoid carrier, and Men B-FHbp, for intramuscular use.

The CPT 2024 Professional Edition and CPT Changes 2024: An Insider’s View are available from the AMA Storefront on Amazon.

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