COVID-19 Vaccine Codes

By: Allison Bloom, Director of Coding Operations & Lisa Messina, Corporate Compliance Officer

Categories: COCID-19 Resources, FQHC, Industry News, PMG Insights Blog

November 20, 2020

November 20, 2020:

The COVID pandemic has had tremendous emergent impact upon medical care, testing and supplies.  In response, the AMA’s CPT Editorial Panel has had to rapidly create and establish new CPT codes for COVID reporting, tracking and analysis to support data-driven planning and resource allocation.

As COVID vaccines are entering final phases of emergency clinical trials, the AMA announced six new vaccine and vaccine administration codes.   The new codes, published on November 10, 2020, apply specifically to the vaccine products.  The first set, in the new coding range that begins with code 91300, applies to vaccines being developed by Pfizer Inc. and Moderna, Inc.; each are hoping to receive Emergency Use Authorizations (EUA) from the Food and Drug Administration (FDA) in the upcoming weeks.  The codes will be available for use and become effective upon approval of the vaccines. The expectation is that as additional new vaccines become available, instructional parenthetical notes will be added throughout the code set directing coders to the applicable COVID-19 vaccine codes. In addition to the new unique vaccine specific codes, the AMA released administration codes unique to each vaccine and dose.

AMA President Susan R. Bailey, MD on why these new codes are important: “An effective national immunization program is key to bringing the coronavirus pandemic to an end.  Correlating each coronavirus vaccine with its own unique CPT code provides analytical advantages to help track, allocate and optimize resources as an immunization program ramps up in the United States.”

NEW VACCINE CODES:

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

NEW VACCINE ADMINISTRATION CODES:

The new vaccine administration codes are specific to each coronavirus vaccine as well as the dose in the required schedule.  This level of specificity offers the ability to track each vaccine dose and include the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers and updating the electronic record.  Because the federal government will be purchasing and distributing initial vaccines to heath care entities across the country, the administration codes will be especially important in specifying which vaccine has been given as well as dosage and which dose (first or second) was given.

0001A  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/0.3mL dosage, diluent reconstituted; first dose
0002A 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/0.3mL dosage, diluent reconstituted; second dose
0011A 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/0.5mL dosage; first dose
0012A 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/0.5mL dosage; second dose

It is important to note that 90460—90474 should not be reported for the administration of the SARS-CoV-2 vaccines.

Vaccine Code and Vaccine Administration Codes Crosswalk

A new Appendix Q is also being added to the CPT code set and will list the product, administration codes, dosing timelines and manufacturer.   This crosswalk will also be used for tracking and reporting outcomes and efficacy of specific vaccines. EUA- approved vaccine product codes will appear with the  symbol for AMA tracking for FDA approval status.  Once a vaccine is approved, the symbol will be removed.

 

Table Source: CPT Assistant Special Edition: Vaccine Coding Development/ Volume 30 2020

The AMA plans to introduce more vaccine-specific CPT codes as more vaccine candidates are close to being approved for Emergency Use by the FDA.  Currently, the AMA has not provided direction on using a combination of vaccines.  This blog will be updated as more information becomes available.

PAYMENT:

The vaccine will be federally purchased and paid for with funding through the CARES Act. The COVID-19 vaccine will be available to patients for free, regardless of coverage status. Beneficiaries will not be required to pay coinsurance, deductibles, or copayments.

For RHCs and FQHCs, payment for COVID-19 vaccines and their administration will be implemented in the same way flu/pneumococcal vaccines are handled.  The COVID vaccines and their administration will be paid at 100 percent of reasonable cost through the cost report. The visit should not be billed, and the costs associated should not be included on the claim.

REFERENCE SOURCES:

https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance

https://www.ama-assn.org/system/files/2020-11/cpt-assistant-guide-covid-vaccine-coding-2020.pdf

https://www.cms.gov/covidvax