Coronavirus Vaccine Billing CPT Codes
The American Medical Association approved two coronavirus vaccine CPT Codes, 91300 and 91301. Two codes are being used to better track, report, and analyze data for the planning and allocation of vaccines for coronavirus. The vaccines are manufactured by are Pfizer and Moderna and require two doses
Four vaccine administration codes, 0001A, 0002A, 0011A, and 0012A have also been added. These administration codes are specific to each of the two vaccines and whether it is the first or second dose given to the patient.
How to bill for Coronavirus Vaccines.
CPT Code for Coronavirus Vaccine
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. (This COVID-19 vaccine is manufactured by Pfizer)
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. (This COVID-19 vaccine is manufactured by Moderna))
COVID-19 Vaccine Administration Codes
The coronavirus vaccine administration codes are specific to the coronavirus vaccine and the dosage. Vaccine administration codes report the work of administering the vaccine, counseling the patient or caregiver, and documenting the medical record.
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. (The 0001A COVID-19 vaccine administration CPT code is for the first dose of the Pfizer vaccine only)
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. (The 0002A COVID-19 vaccine administration CPT code is for the second dose of the Pfizer vaccine only)
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. (The 0011A COVID-19 vaccine administration CPT code is for the first dose of the Moderna vaccine only)
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. (The 0012A COVID-19 vaccine administration CPT code is for the second dose of the Moderna vaccine only)
How to Bill for COVID-19 Vaccine
Proper medical billing for the Coronavirus vaccine is important for not only reimbursement but governmental reporting purposes.
Each Coronavirus vaccine has its own specific CPT code based on the vaccine manufacturer (Pfizer or Moderna). The vaccine administration code is also based on the manufacturer plus the number of doses.
If you receive the COVID-19 Vaccine form the government to administer to patients, remember to only bill the vaccine administration codes when submitting claims. DO NOT include the vaccine CPT codes when the Coronavirus vaccines are free.
Here is an example of how to bill for the Pfizer COVID-19 vaccine:
Pfizer COVID-19 Vaccine First Dose:
- Vaccine CPT: 91300
- Administration: 0001A
- ICD-10: Z23
NDC: 59267-1000-01
Pfizer COVID-19 Vaccine Second Dose:
- Vaccine CPT: 91300
- Administration: 0002A
- ICD-10: Z23
- NDC: 59267-1000-01
Here is an example of how to bill for the Moderna COVID-19 vaccine:
Moderna COVID-19 Vaccine First Dose:
- Vaccine CPT: 91301
- Administration: 0011A
- ICD-10: Z23
- NDC: 80777-0273-10
Moderna COVID-19 Vaccine Second Dose:
- Vaccine CPT: 91301
- Administration: 0012A
- ICD-10: Z23
- NDC: 80777-0273-10
How will the COVID-19 Vaccine be Reimbursed?
The Federal Government will be providing the Coronavirus Vaccine when it first comes out. So there will be no reimbursement for the vaccines themselves. However ther will be reimbursement for the administration of the COVID-19 vaccine.
Here are the proposed reimbursement rates from CMS:
- First Dose: $ 16.94
- Second Dose: $ 28.39
Rates will be adjusted by geographic location.
Keep in mind things are still changing so come back for updates and more coronavirus vaccine news.
Fact Sheet for Healthcare Providers Administering Vaccine
The FDA has come out with a fact sheet for healthcare providers regarding the limitations and authorized use of the new Pfizer-BioNTech COVID-19 Vaccine.
Here is the link to the Fact Sheet: https://www.fda.gov/media/144413/download
CMS Updated Payment and HCPCS Level 1 CPT Code Structure
There is an updated payment and code structure that has been put out by CMS that has specific COVID-19 vaccine information.
Here is the link to the update: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies
Have you added these codes to your EHR and medical billing software? Leave a comment below.
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What is the administration code for Moderna Booster #2?
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As it states that you cannot bill for the COVID vaccine if received free of charge, Why is the CPT 91300 included to be billed? All offices receive it free of charge.
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We a rural health clinic trying to bill the Moderna admiration fee. It is asking for 2 modifiers. I can’t seem to find the modifiers is asking for? Is there modifier required for 0011a and 0012a?
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When someone comes to a clinic for a covid vaccine ONLY, can an E/M code be billed with it? Patient is not an established patient with the particular clinic giving the jab. No other health issues for said patient.
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THANK YOU FOR YOUR HELP DURING THIS TIME. BILLING CHANGES DAILY AND THIS HAS BEEN A HELP TO ME
L BATES, BILLER
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MINERAL WELLS, TX
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Hello—would you happen ton know what price is fair to charge for the Administration of the Covid Vaccine?
Hi Frank —
CMS has come up with the following proposed national reimbursement rate for the administration of the COVID vaccine.
First Dose CMS Reimbursement: $ 16.94
Second Dose CMS Reimbursement: $ 28.39
We and a lot of medical practices typically look at charging 150% of Medicare which would be:
First Dose Charge: $ 26.00
Second Dose Charge: $ 43.00
However, some practices set fees at 200% to 300% of Medicare. It’s really up to the practice what they want to charge.
Hope this helps.
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