Medicare Compliance & Reimbursement

On May 4, the American Medical Association (AMA) announced provisional CPT® codes for the yet-to-be approved COVID-19 vaccination from Novavax Inc.

The AMA decided to release codes before the Food and Drug Administration (FDA) Emergency Use Authorization (EUA) approval of the Novavax COVID-19 Vaccine “to ensure electronic systems across the U.S. health care system are prepared in advance,” explains an AMA release on the update.

Here’s a breakdown of the CPT® codes for the Novavax vaccine and vaccine administration:

• 91304 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage, for intramuscular use)
• 0041A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage; first dose)
• 0042A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage; second dose)

The Novavax vaccine will be a two-dose vaccination similar to the Pfizer and Moderna vaccines.