Resolved COVID Vaccine Coding

[NatashaP_63838]

Hi everyone,

For the Moderna or Pfizer vaccine, when billing, are we supposed to use the CPT 91301 of course at a zero charge, plus the administration code 0011A/0012A. I'm confused if both codes should be going out together or only the administration code?

 

[Lori]

There is a COVID thread for club members here:
https://www.cco.community/threads/coronavirus-covid-19-coding-and-industry-updates.3451/

COVID-19 Vaccines and Monoclonal Antibodies​

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Medicare Part B Payment for COVID-19 Vaccines and Certain Monoclonal Antibodies during the Public Health Emergency
CMS has released a set of toolkits for providers, states and insurers to help the health care system prepare and assist in swiftly administering these products once they become available. These resources are designed to increase the number of providers that can administer the products and ensure adequate reimbursement for administration in Medicare, while making it clear to private insurers and Medicaid programs their responsibility to cover these products at no charge to beneficiaries. This webpage provides the payment allowances and other related information for these products. For more information, review the COVID-19 provider toolkit.

COVID-19 Vaccines and Monoclonal Antibodies | CMS

The COVID-19 public health emergency (PHE) ended at the end of the day on May 11, 2023. View Infectious diseases for a list of waivers and flexibilities that were in place during the PHE.

www.cms.gov

The American Medical Association has published the first set of COVID-19 vaccine and administration codes(www.ama-assn.org). The codes, which were recently approved by the CPT Editorial Panel, have a unique structure that will allow for tracking and accommodating multiple new COVID-19 vaccines. CPT immunization codes 90460-90474 will not be used for COVID-19.
The first codes are for vaccines produced by Pfizer and Moderna. Additional codes will be released as more COVID-19 vaccines are approved. Each will have its own vaccine code and administration codes. The Pfizer and Moderna vaccines require two doses, so each vaccine has two administration codes to indicate which dose was administered. The administration codes include counseling, when performed.

Manufacturer	Vaccine Code	Description	Administration Codes
Pfizer	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	• 0001A (1st dose) • 0002A (2nd dose)
Moderna	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	• 0011A (1st dose) • 0012A (2nd dose)

The AMA has published a special edition CPT Assistant guide(www.ama-assn.org), which includes an appendix(www.ama-assn.org) to help identify each vaccine’s product code and administration code.

First COVID-19 vaccine CPT codes published

The first COVID-19 vaccine and administration codes are for products produced by Pfizer and Moderna.

www.aafp.org

 

[WhitneyH_24046]

Thanks Lori!