What’s the news: The Current Procedural Terminology (CPT®) code set has been updated to include vaccine and administration codes for pediatric doses of the COVID-19 vaccine developed by Pfizer.
The provisional CPT codes will be effective for use on the condition that Pfizer’s two-dose regimen for the prevention of COVID-19 in children 5–11 gets approval or emergency use authorization (EUA) from the Food and Drug Administration (FDA). The AMA is publishing the CPT code update now to ensure electronic systems across the U.S. health care system are prepared in advance for the potential FDA approval or authorization.
“The AMA supports the goal of extending COVID-19 immunization protection to a broader age range of children,” said AMA President Gerald E. Harmon, MD.
Dr. Harmon noted that “a rigorous, transparent review process” by the FDA and Centers for Disease Control and Prevention “will examine the safety and efficacy of Pfizer’s COVID-19 vaccine for potential use in children” aged 5–11.
Pfizer has applied for an EUA and the FDA Vaccines and Related Biological Products Advisory Committee will meet to discuss the vaccine Oct. 26.
The development of manufacturer-specific vaccine CPT codes has clinically distinguished each coronavirus vaccine and dosing schedule for better tracking, reporting and analysis that supports data-driven planning and allocation. COVID-19 vaccines from AstraZeneca, Janssen (Johnson & Johnson), Moderna, Novavax and Pfizer have previously been issued unique CPT codes.
Last month, the CPT code set was updated to include vaccine and administration codes that are unique to a new formulation of the COVID-19 vaccine developed by Pfizer. The new formulation is based on a tris-sucrose buffer rather than the phosphate buffer present in the original formulation.
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 disease.
Why it’s important: “Data-driven planning and resource allocation is vital for effective immunization programs that will bring the coronavirus pandemic to an end,” Dr. Harmon has noted previously. “Correlating each coronavirus vaccine and dosing schedule with its own unique CPT code has provided necessary analytical advantages to help track, allocate and optimize resources for immunization programs across the United States.”
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.
This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology so it can fulfill its vital role as the trusted language of medicine today and the code to its future.
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.
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