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COVID-19 Vaccine Codes

March 30, 2021

By Allison Bloom, Director of Coding Operations, and Lisa Messina, Corporate Compliance Officer, FQHC Division of Coronis Health

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 November 10, 2020, the AMA announced the coding methodology to be applied for new vaccine and vaccine administration codes that apply specifically to COVID vaccine products. The codes become effective upon Emergency Use Authorization (EUA) approval of the vaccines.  

As new vaccines continue to become available, instructional parenthetical notes are 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 releases administration codes unique to each vaccine and dose.  

The first COVID Vaccine, a Pfizer product, was granted an Emergency Use Authorization (EUA) on December 12, 2020, allowing providers to begin administering the vaccine to the American public. Moderna’s EUA was granted December 18, 2020, bringing a second vaccine to the public. Janssen’s single dose vaccine received it’s EUA on February 27, 2021. The AstraZeneca vaccines are continuing through the EUA process; however, the AMA has already provided the codes for these vaccines to give providers the necessary lead time to set them up in their record and billing systems. 

The new vaccine administration codes are specific to each coronavirus vaccine as well as to 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 healthcare 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. Unlike the other vaccines, Janssen’s EUA application is for a single-dose vaccine. 

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.”

New Vaccine and Vaccine Administration Codes

Vaccine Code DescriptionVaccine CodeVaccine Administration DescriptionVaccine Code
Pfizer Vaccine (EUA December 12, 2020): 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
91300

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 doseImmunization 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

0001A



0002A
Moderna Vaccine (EUA December 18, 2020): 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
91301

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 doseImmunization 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 

0011A 



0012A 
AstraZeneca Vaccine (EUA Pending): 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
91302

Immunization administration by intramuscular injection of 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; first doseImmunization administration by intramuscular injection of 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; second dose

0021A





0022A
Janssen Vaccine (EUA February 27, 2021 ): Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use
91303

Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, single dose

0031A

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 FDA approved, the symbol will be removed. 

Table Source: https://www.ama-assn.org/system/files/2020-11/covid-19-immunizations-appendix-q-table.pdf

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.

FAQs

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.

Beneficiaries with Medicare pay nothing for COVID-19 vaccines from the federal government, and there is no applicable copayment, coinsurance, or deductible.

Q: What is a lump sum payment?
A: In the April 1, 2021 MLN Connects, CMS announced that Federally Qualified Health Centers (FQHCs) may request lump sum payments for administering COVID-19 vaccines in advance of cost report settlement. CMS will pay health centers for COVID-19 vaccines and administration at 100% reasonable cost like influenza and pneumonia vaccines. Health centers are advised to contact their MACs for more information.

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. Medicare Advantage administrative fees are reported on health center cost reports. Medicare Advantage beneficiaries do not pay a cost-share for the vaccine.

Q: How will Medicaid reimburse providers for COVID vaccines and administration?
A:  The toxoid vaccine is provided for free to all Medicaid beneficiaries. State Medicaid and CHP agencies must provide vaccine administration without cost-sharing to all beneficiaries through to the end of the PHE. Through the American Rescue Act signed by President Biden on March 11, 2021, vaccine administration will be federally funded. As more information is not yet available, 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 purposes, the applicable vaccine toxoid code should also be submitted with no fee attached. 

Q: Some of our patients are private plan beneficiaries. How do we bill for the vaccine and its administration?
A: Most private health plans are required to cover the vaccine and its administration, both in-network and out-of-network, with no cost-sharing during the PHE. Medicare reimbursement rates should be referred to as a potential guideline for insurance companies paying a FFS rate. CMS expects commercial carriers to ensure that their rates are reasonable compared with market rates. On March 15, 2021, CMS increased reimbursement to $40 to administer each dose of the vaccine. 

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.

Reference Sources

https://public-inspection.federalregister.gov/2020-26815.pdf

https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration

https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance

https://www.ama-assn.org/system/files/2020-11/cpt-assistant-guide-covid-vaccine-coding-2020.pdf

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