What’s the news: The AMA has published an update to the Current Procedural Terminology (CPT®) code set that includes new vaccine-specific codes to report immunizations for the new coronavirus, SARS-CoV-2, that are unique to the COVID-19 vaccine under development by Novavax Inc.
Working closely with the Centers for Disease Control and Prevention, the CPT Editorial Panel has approved a unique CPT code for each of five coronavirus vaccines—those from Pfizer-BioNTech, Moderna and Johnson & Johnson that have received emergency use authorization (EUA) from the Food and Drug Administration (FDA), along with vaccines made by AstraZeneca and Novavax still awaiting EUA—as well as administration codes unique to each such vaccine.
The CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting and analysis that supports data-driven planning and allocation. The CPT codes will facilitate the updating of health care electronic systems across the U.S. The AMA also published advice COVID-19 immunization administration and E/M visits.Why it’s important: “Relying on multiple manufacturers to produce different COVID-19 vaccine products helps to avoid possible supply disruptions and supports the needed volume of doses,” said AMA President Susan R. Bailey, MD. “However, accurately correlating vaccinated patients with one of the available COVID-19 vaccines is critical for managing immunizations. This challenge is managed with unique CPT codes that clinically distinguish each COVID-19 vaccine and provide the needed informational precision to ensure optimal vaccine distribution and administration.”
For quick reference, the Category I CPT codes and long descriptors for the vaccine products are:
- 91300: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use.
- 91301: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use.
- 91302: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use.
- 91303: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use.
- 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/0.5mL dosage, for intramuscular use.
In accordance with the new vaccine-specific product CPT codes, the CPT Editorial Panel has worked with the Centers for Medicare & Medicaid Services to create new vaccine administration codes that are both distinct to each coronavirus vaccine and the specific dose in the required schedule. This level of specificity is a first for vaccine CPT codes, which offers the ability to track each vaccine dose, even when the vaccine product is not reported on a claim—for example, when the vaccine may be given to the patient for free.
These CPT codes are used to report the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers and updating the electronic record.
Learn more: All the vaccine-specific CPT codes published here will be available for use and effective when that particular coronavirus vaccine gets emergency use authorization or approval from the FDA.
Short, medium and long descriptors for the new vaccine-specific CPT codes can be accessed on the AMA website, along with several other recent modifications to the CPT code set that have helped streamline the public health response to the SAR-CoV-2 virus and the COVID-19 disease.
Part of the AMA’s COVID-19 CPT guidance, the “Find your COVID-19 Vaccine CPT Codes” resource, helps you determine the appropriate CPT code combination for the type and dose of vaccine that you are using. With the rapidly expanding availability of different vaccines coming to market, understanding the appropriate reporting for the vaccine that physicians and qualified health care professionals plan to deliver to patients is critical.
Questions on CPT coding and content should be directed to the CPT Network, the authoritative source for CPT coding answers.
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