Medicare Compliance & Reimbursement
Here’s The Scoop On COVID-19 Vax Coding Updates
Figure out which code survived the chopping block. Although the COVID-19 public health emergency (PHE) ended last May, the need for updated COVID-19 vaccines remains, and updates to the CPT® code set reflect that need. Nuts and bolts: To streamline reporting, the American Medical Association (AMA) created new codes that effectively consolidate the over 50 previous COVID-19 immunization codes. And now that Nov. 1, 2023, is in the rearview mirror, all previously approved COVID-19 vaccine product and vaccine administration codes have been deleted from the CPT® code set, with one exception. How are you adjusting to all these changes? With COVID-19 cases and hospitalizations on the rise, you need to have a solid grasp on the new reporting practices, so you can continue to code COVID-19 vaccine services correctly. Understand These COVID-19 Vaccine Coding Basics Wondering what’s behind the AMA scrapping almost all of the COVID-19 vaccine administration and product CPT® codes and replacing them with a shorter list of product codes and a single administration code? This overhaul was prompted by the Food and Drug Administration’s (FDA’s) recommendation to shift to a monovalent COVID-19 vaccine that targets the predominant XBB lineage virus strain for the 2023-2024 vaccine season. Why? COVID-19 vaccinations are likely to have annual updates (like flu shots), so the codes need to work for these yearly changes. Also, since the PHE has officially ended, the codes no longer require the same level of specificity for tracking purposes. Check Out the New Codes CPT® introduced new monovalent COVID-19 vaccine product codes for Pfizer and Moderna vaccines, which took effect upon FDA approval on Sept. 11, 2023. The codes vary based on the dosage. Also added is a new administration code for use with any COVID-19 vaccine for patients of all ages. Pfizer: Use the following codes for Pfizer’s new monovalent vaccines: Moderna: Report these codes for Moderna’s new monovalent vaccines: Administration: Scrap all previous specific vaccine administration codes, and instead submit the following with all COVID-19 vaccine product codes: Like the previous vaccine administration codes, counseling is bundled with 90480, so be sure to not report that as a separate service. Remember: This administration code is for COVID vaccines only. Do not report 90480 in conjunction with non-COVID products. Say Goodbye to All But One Previous COVID Code As mentioned, CPT® deleted all previously approved COVID-19 vaccine product and vaccine administration codes, effective Nov. 1, 2023. The one exception is 91304 (Severe acute respiratory syndrome coronavirus 2 … vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use) for the Novavax vaccine, which will continue to be available for use. As part of this large code update, CPT® removed the words “preservative free” from the descriptor for the Novavax product code in mid-August. And now that the new admin code is active, you will pair 91304 with 90480. Don’t miss: Since the AMA made these codes effective after releasing the 2024 CPT® code set, the codes will be published in the 2025 CPT® code set. Make Sure To Ignore Appendix Q Because of this code consolidation, Appendix Q, which was created to house the specific codes for COVID-19 vaccines, was also deleted on Nov. 1, 2023. To assist CPT® code users in differentiating and reporting the available vaccine product codes and the associated immunization administration codes appropriately, the AMA established a website (www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance) that features timely updates. This development is likely to bring a sigh of relief to coders. The pandemic led to the creation of many new codes and frequent updates that made keeping up to date a challenge. “Halleluiah!” exclaimed Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont. “The burden of frequent code changes due to the rapid development of more vaccines, as well as the use of manufacturer-specific codes, complicated vaccine administration and billing operations at the worst possible time. This simplification comes as relief during some of the busiest, leanest times in the 30 years I have been doing this work.” Note: The CPT® panel decided to delete these codes after the finalization of the CPT® 2024 code book. Therefore, all of the deleted codes, including Appendix Q, you can find in your copy of CPT® 2024, per CPT® Assistant August Update (Number 8, 2023). This is why it’s particularly important to refer to the AMA site to reference the most up-to-date information. Gain More Insight Into Why This Is Happening The Vaccines and Related Biological Products Advisory Committee (VRBPAC), an advisory group of the FDA, recommended that, in light of the PHE expiration on May 11, there is no longer a need for the extensive granularity of the previously approved vaccine and administration codes. Therefore, CPT® will switch to annual COVID-19 vaccine updates, similar to their updates for influenza vaccinations. The VRBPAC met recently to discuss which strain(s) of the COVID-19 virus should be included in a vaccine for the 2023-2024 vaccination season and recommended that the COVID-19 vaccine for the 2023-2024 vaccination season be a monovalent vaccine that contains the XBB.1.5 strain. Resources: Find more guidance from the Centers for Disease Control and Prevention (CDC) regarding which patients should receive a COVID-19 vaccine at www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/overview-COVID-19-vaccines.html.
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