Recently, the Centers for Disease Control and Prevention (CDC) announced that certain people who have received a Pfizer-BioNTech or Moderna Covid-19 vaccine are now eligible to receive a Covid-19 booster shot. The people eligible to receive the third dose of the Covid-19 vaccine after 6 months or more of their initial series are:
- Individuals who are 65 years or older
- Individuals who are 18+ and live in long-term care settings
- Individuals who are 18+ and are immunocompromised due to an underlying medical condition
- Individuals who are 18+ and live in or work at high-risk settings such as a hospital
With this announcement also comes the introduction of two new Covid vaccine CPT codes for the documentation of the third dose of the vaccine. The American Medical Association (AMA) has released two new Covid-19 vaccine CPT codes for the additional dose of the vaccine.
CPT Codes for Covid-19 Vaccine Third Dose
In July, the AMA announced the creation of a provisional CPT code unique to a potential third dose of the Pfizer Covid-19 as federal agencies continued to review emerging evidence on the need for a third dose of the vaccine. This provisional administration CPT code for the Pfizer booster shot was created to ensure that electronic health systems are prepared and can meet the immediate needs of the health system if the third dose shots received approval from the federal agencies.
Effective August 12, the Centers for Medicare & Medicaid Services announced that it will cover the administration of the third Covid-19 vaccine dose at the same rate as the others i.e around $40.
Following the US Food and Drug Administration’s recent approval of the third dose of the Covid-19 vaccine, the CPT Editorial Panel accelerated the new CPT code for the third dose of the Moderna vaccine.
Covid vaccine administration codes that are now available for immediate use for documentation of the administration of the third dose of the Moderna and Pfizer-BioNTech vaccines are:
- Pfizer; 0003A – Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3mL dosages, diluent reconstituted; the third dose
- Moderna; 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; the third dose
To facilitate the tracking of the vaccines administered, these new administration codes for the Covid-19 vaccine are differentiated by specifics such as their dosage and if they were diluent reconstituted.
These newly released Covid-19 vaccine administration codes will not only be used to report the actual administration of the third dose but also the necessary counseling provided to patients or caregivers regarding the vaccine as well as the work of updating the electronic health records.
These codes are effective immediately owing to their Emergency Use Authorization approval from the Food and Drug Administration (FDA). Since these codes and their descriptors are available for immediate use, they may not be reflected in the 2021 CPT codebook. Thus, they may need to be uploaded manually into Electronic Health Records and other health systems by healthcare organizations.
The AMA’s code finder resource lays out the Covid-19 vaccine CPT codes and their long, short, and medium descriptors for every type of vaccine and each accompanying dose number to ensure accurate coding and reporting of Covid-19 vaccines and administration services.
Coding for COVID-19 Vaccine Shots
The AMA has published an update to the Current Procedural Terminology (CPT) code set to include new Covid vaccine CPT codes to report the immunizations against the coronavirus. The CPT Editorial Panel has worked closely with the CDC to create three unique CPT codes for each of three Covid-19 vaccines – Pfizer-BioNTech, Moderna, and the AstraZeneca/University of Oxford.
The Category I CPT codes and long descriptors for the vaccine products are:
- 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 dosages, diluent reconstituted, for intramuscular use.
- 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 dosages, for intramuscular use.
- AstraZeneca; 91302 (2nd Dose)– Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.
|Vaccine Code||Vaccine Administration Code(s)||Manufacturer||Vaccine Name(s)||NDC 10/NDC11|
|91300||0003A (3rd Dose)||Pfizer, Inc||Pfizer-BioNTech COVID-19 Vaccine||59267-1000-159267-1000-01|
|91301||0013A (3rd Dose)||Moderna, Inc||Moderna COVID-19 Vaccine||80777-273-1080777-0273-10|
|91305||0053A (3rd Dose)||Pfizer, Inc||Pfizer-BioNTech COVID-19 Vaccine||59267-1025-159267-1025-01|
Different vaccines also have a different associated administration code that is specific to that certain coronavirus vaccine and its dosages.
The administration codes for the Pfizer vaccine are:
- 0001A – First dose
- 0002A – Second dose
- 0003A – Third dose
The administration codes for the Moderna vaccine are:
- 0011A – First dose
- 0012A – Second dose
- 0013A – Third dose
For example, if a medical coder wants to report the administration of the first dose of the Pfizer vaccine to a patient, he will use the following codes:
- Vaccine CPT Code: 91300
- Administration Code: 0001A
- ICD-10: Z23
- NDC: 59267-1000-01
Similarly, if the coder wants to report the administration of the second dose of the same vaccine, he will use the same codes except the administration code used this time around will be 00021A instead of 0001A. Likewise, administration code 0003A will be used to document the third dose of the Pfizer vaccine.
Let’s take another example. If a medical coder wants to bill for the first-dose immunization of a patient against the Coronavirus using the Moderna vaccine, he will use the following codes:
- Vaccine CPT Code: 91301
- Administration Code: 0011A
- ICD-10: Z23
- NDC: 80777-0273-10
Similarly, if a coder wants to bill for the administration of the second dose of the Moderna vaccine, he will use the following codes:
- Vaccine CPT Code: 91301
- Administration Code: 0012A
- ICD-10: Z23
- NDC: 80777-0273-10
And to report the third dose of the same vaccine, the coder will use the administration code 0013A.
More CPT codes for the Covid vaccine and their associated administration codes can be found on the AMA website.
Codes for administering the vaccine in the patient’s home
If the vaccine is administered to a patient in their home, the medical coder should use the HCPCS Level II code M0201 to bill for the additional payment. This code is to be used in addition to the appropriate Covid vaccine CPT code and dose-specific administration code. You can only report the HCPCS Level II code for home vaccine administration once per home per date of the vaccine administration.
The bottom line
As we move towards different stages of the pandemic, getting vaccinated is our only pathway towards returning to normal. Increased vaccinations among healthcare workers work to not only reduce the spread of the pandemic but also allow them to continue to help those in need of care. And as important it is to get vaccinated, it is also important to know how to code for the administration of the Covid-19 vaccine. With more than 300 million doses administered in the United States, medical coders must know how to accurately report and document the administration of the vaccine.