What’s the news: The Current Procedural Terminology (CPT®) code set has been updated to include booster doses of the COVID-19 vaccine created by the Janssen Pharmaceutical Companies of Johnson & Johnson (J&J).
The CPT Editorial Panel previously updated the code set to include booster doses for the Moderna and Pfizer-BioNTech vaccines. The effective dates for COVID-19 related vaccine CPT codes coincide with their emergency use authorization from the Food and Drug Administration (FDA).
While boosters for adults who received the two-dose regimen Pfizer and Moderna vaccines are available six months after the second shot, boosters are available after only two months for adults who received the one-shot J&J vaccine.
The new code assigned to the Janssen booster for the COVID-19 vaccine is:
- 0034A Immunization administration by intramuscular injection of 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/0.5 mL dosage; booster dose.
Read what doctors wish patients knew about the Johnson & Johnson vaccine.
Why it’s important: The emergence of the COVID-19 Delta variant as the dominant strain of SARS-CoV-2 in the United States triggered a decline in vaccine effectiveness, particularly among seniors. But data indicates that receiving a booster dose of Moderna, J&J or Pfizer COVID-19 vaccines increases immune response.
The Centers for Disease Control and Prevention (CDC) also recently gave the green light for safely mixing and matching the shots, giving patients more options for protection against COVID-19.
“We believe the FDA’s authorization and the CDC's recommendations in support of booster doses, including the option to mix-and-match boosters with authorized vaccines, will help provide continued protection against COVID-19 for those who need it most,” said AMA President Gerald E. Harmon, MD.
The mix-and-match option authorized for COVID-19 vaccines and boosters provides needed flexibility for efficient and effective vaccination programs. The CPT code set is prepared to support this strategy with product-specific CPT codes that clinically distinguish each coronavirus vaccine and booster to facilitate reporting and analysis that is needed for data-driven planning and allocation as booster programs get rolled out.
The codes also facilitate the specialized tracking needs of the CDC and CMS by identifying two code groups. One identifies a specific vaccine product and the other provides a vaccine administration code that is both vaccine and dose specific.
The boosters are recommended for anyone over 65, anybody 18 or older with an underlying medical condition, and people who live or work in high-risk settings. Underlying medical conditions include cancer, cerebrovascular disease, cardiovascular disease, kidney disease, chronic obstructive pulmonary disease or other lung diseases, diabetes and various heart conditions. Physicians and patients should consult current CDC and FDA guidance on the appropriate eligibility criteria.
Learn more: Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel that collects broad input from the health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care system.
Short, medium and long descriptors for all the new vaccine-specific CPT codes can be accessed on the AMA website, along with other recent modifications to the CPT code set that have helped streamline the public health response to the SARS-CoV-2 virus and the COVID-19 epidemic.
To help ensure accurate coding and reporting of COVID-19 vaccines and immunization services, the AMA vaccine code finder resource helps identify the appropriate CPT code combination for the type and dose of COVID-19 vaccine provided to each patient.
To keep informed about CDC news, clinical information, and more visit the AMA COVID-19 vaccine development section.
