6 New CPT Codes for COVID-19 Vaccines

Coronavirus Vaccine Update – Billing Codes Just Released

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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