November 20, 2020
Updated December 22, 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.
On December 12, 2020, the Pfizer COVID Vaccine was granted an Emergency Use Authorization (EUA) allowing providers to begin administering the vaccine to the American public. Moderna’s EUA was approved December 18, 2020 bringing a second vaccine to the public.
On November 10, 2020 the AMA announced six new vaccine and vaccine administration codes that apply specifically to these vaccine products. The codes became effective upon EUA approval of the vaccines. The first code in the new coding range, 91300, applies to the Pfizer Inc. while 91301 applies to the Moderna, Inc. vaccine. Individuals require two doses of each vaccine. 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.”
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 is 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.
Pfizer Vaccine Administration Codes:
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
Moderna Vaccine Administration Codes:
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.
Please note that the guidance is changing on an almost-daily basis. It is important to check with your payers to get the most accurate information specific to your health center.
Q: How will Medicare payments to health centers for COVID-19 vaccines and their administration be implemented?
A: Payment will be implemented the same way flu/pneumococcal vaccines are currently provided. According to the NACHC, these vaccines and their administration are paid at 100 percent of reasonable cost through the cost report. No visit is billed if it is a vaccination only encounter, and these costs should not be included on the claim. Cost sharing is waived. CMS has provided COVID vaccine policies and guidance: https://www.cms.gov/covidvax
Q: How will Medicaid reimburse providers for COVID vaccines and administration?
A: Medicaid programs must compensate Medicaid providers for vaccines and administration. If the vaccine is free to patients, Medicaid must still compensate providers for the administration fee or office visit. It is important to note that Medicaid reimbursement varies by state and type of arrangement (i.e., Managed care or FFS) and communication with the plan’s point-of-contact for details on how to submit claims is important.
Q: We received the COVID vaccine toxoid for free, can we bill for the vaccine administration?
A: The vaccine administration code applicable to the product and dose should be submitted on the claim. For tracking purpose, the applicable vaccine toxoid code should also be submitted with no fee attached.
Q: How will I get reimbursed for administering the COVID vaccine to my uninsured patients?
A: Providers administering the vaccine to people without health insurance or whose insurance does not provide coverage of the vaccine, can request reimbursement for COVID-19 vaccine administration through the CARES Act Provider Relief Fund, see https://www.hrsa.gov/CovidUninsuredClaim. The program will provide vaccine administration codes to use for claims submission on their webpage, so be sure to check there frequently.
Q: If a patient is coming in for a COVID vaccination only, do I use an E&M Code?
A: No, for vaccination-only visits, code the specific vaccine and the corresponding administration code for the vaccine. If the vaccine is free, code only the administration code.
Q: What about Medicare Advantage?
A: If you participate in a Medicare Advantage Plan, CMS advises providers to submit the COVID-19 vaccination claims to Original Medicare through your MAC.