New CPT codes for coronavirus vaccines: What you need to know

Kevin B. O'Reilly , Senior News Editor

What’s the news: The AMA has published updates to the Current Procedural Terminology (CPT®) code set to include new administration codes that are unique to a third dose of the current COVID-19 vaccines offered by Pfizer and Moderna.

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The CPT codes, updated by the CPT Editorial Panel, will be effective for use now that a third dose shot of the Pfizer and Moderna COVID-19 vaccines have received emergency use authorization from the U.S. Food and Drug Administration (FDA) for certain patients with compromised immune systems.

For quick reference, the vaccine administration CPT code and long descriptor assigned to the third doses of the current Pfizer and Moderna COVID-19 vaccines are:

0003A: 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; third dose.

0013A - 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, 100 mcg/0.5 mL dosage; third dose.

These CPT codes and descriptors 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.

Short, medium and long descriptors for all 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 SARS-CoV-2 virus and the COVID-19 disease.

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Why it’s important: “Given that Centers for Disease Control and Prevention (CDC) data shows some immunocompromised patients lack the antibodies needed to fight COVID-19 infection, adding an additional dose to the primary series for this population can help protect these individuals from unnecessary hospitalizations and deaths,” said AMA President Gerald Harmon, MD. “It is important to keep in mind that this recommendation is for a limited population and an additional dose of COVID-19 vaccine is not recommended for all fully vaccinated people at this time.”

In accordance with the vaccine-specific product CPT codes, the CPT Editorial Panel has worked with the Centers for Medicare & Medicaid Services to create 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.

Working closely with the CDC, 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.

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Learn more: 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. To stay informed about the latest news from the CDC, guides, clinical information, and more visit the COVID-19 vaccine development section.