Pediatric Coding Alert

Reference CPT^® Appendix Q for help matching vaccines with their admin codes.

COVID-19 is alive and well, and to help keep us all going, more vaccines are becoming administrable to younger populations. Recently, a vaccine and several sets of administration criteria have received emergency use authorization (EUA) by the Food and Drug Administration (FDA), and the CPT^® editorial panel recently responded by approving four new COVID-19 Moderna vaccine administration codes, retroactively effective as of June 17, 2022.

Here you’ll find the new codes, and everything you need to report them properly.

Use These Administration Codes With 91309 for Ages 6-11

You’ll use the following administration codes in conjunction with established Moderna vaccine product code 91309 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use):

• 0091A (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, 50 mcg/0.5 mL dosage; first dose, when administered to individuals 6 through 11 years)
• 0092A (… second dose, when administered to individuals 6 through 11 years)
• 0093A (… third dose, when administered to individuals 6 through 11 years)

Coding alert: Not all patients 6-11 years old are eligible for the third dose. When reporting 0093A, make sure the documentation clearly shows the practitioner’s reasoning behind labeling the patient as moderately to severely immunocompromised. For more on COVID-19 vaccination for this population, the Centers for Disease Control and Prevention (CDC) offers the following guidance: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html.

Revision alert: Now that there are differentiating age ranges for administration of the Moderna vaccine coded with 91309, the panel also updated the code descriptor for administration code 0094A (… booster dose…) to include “when administered to individuals 18 years and over.”

Use This Code With 91311 for Ages 6 Months-5 Years

CPT^® has also added an administration code for use with 91311 (… 25 mcg/0.25 mL dosage…), the Moderna vaccine authorized for emergency use for pediatric patients aged 6 months through 5 years:

• 0113A (… third dose)

This is another code you’ll only use for patients who are moderately to severely immunocompromised. The practitioner will have made the determination that the patient was a candidate for the third dose of the vaccine, and that determination should be made clear in the notes.

Observe New Age Range for 91301 and its Admin Codes

The FDA approved 91301 (…100 mcg/0.5 mL dosage…) and its corresponding administration codes for patients as young as 12. Though it was previously only approved for patients 18 and older, there are no descriptor revisions related to this vaccine. You should continue using 91301 with 0011A (Immunization administration… 100 mcg/0.5 mL dosage… first dose), 0012A (… second dose), and 0013A (… third dose).

Review the Coding Structure

“The development of these codes has been the most detailed process for vaccines within the CPT^® code set,” says Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. Traditionally, there have been one or two codes used to identify the vaccine itself, then a range of codes for administration.

But for these COVID-19 vaccines, administration codes are specific to their associated vaccine. That means you are to report administration codes 0091A, 0092A, 0093A, and 0094A with product code 91309, you’re to report 0113A with product code 91311, and so on. Because this is a relatively new coding structure, it’s essential to stay on top of it. “Ongoing education and reading are important. Use the tools and resources available, such as CMS [Centers for Medicare & Medicaid Services] and AMA to ensure your office is up to date on the latest coding matrix,” Johnson says.

Remember: The CPT^® manual includes Appendix Q, which was recently reformatted to include age ranges for all the COVID-19 vaccine and vaccine administration codes. The appendix is in the form of a table that clearly organizes the information you need to distinguish which administration codes go with which vaccines.

Keep Up With New Vaccine Information

The announcement of 0091A, 0092A, 0093A, and 0113A comes just a few weeks after CPT^® announced the addition of Pfizer’s new vaccine administration code 0083A (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, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose). “It’s easy to get confused, and we will continue to see more updates. Having a good understanding of the differences among dosages, age ranges, and manufacturers of these vaccines is essential,” says Laidy Martinez, CPC, CGIC, CASCC, profee coder at Children’s Health of Orange County in Orange County, California. For further assistance differentiating the available immunization codes, check out: https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes.

Note: All codes mentioned above are currently effective, but won’t appear in the print version of CPT^® until 2024.