Pediatric Coding Alert

Question: What is the current status of pediatric COVID-19 vaccines? I know the Pfizer-BioNTech vaccine has been approved by the Food and Drug Administration (FDA) and authorized by the Centers for Disease Control and Prevention (CDC), but what is the current status of the Moderna and Johnson & Johnson/Janssen vaccines for children?

New York Subscriber

Answer: Pfizer-BioNTech: As of May 20, 2022, the CDC has only authorized the Pfizer-BioNTech vaccine for pediatric use, recommending two doses of the lower-dose formula for children ages 5-11, and two doses of the adult formula along with a booster shot for children ages 12 and over (www.cdc.gov/ coronavirus/2019-ncov/vaccines/vaccines-children-teens. html).

The relevant CPT^® codes for the Pfizer-BioNTech vaccine and its administration to the 5-11 age group are as follows:

• Vaccine: 91307 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preser­vative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use)
• Administration: 0071A (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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose); 0072A (… second dose).

On May 17, the FDA did authorize the use of a single booster for the 5-11 age group “at least five months after the completion a primary series” with the Pfizer-BioNTech COVID-19 vaccine. The administration code for that is 0074A (… booster).

CPT^® has assigned other codes for the Pfizer-BioNTech vaccine and administration for children ages 6 months through 4 years, but the vaccine is still awaiting FDA approval. Even though you cannot use them, you can find them by clicking on the link to the CPT^® Appendix Q table below.

Moderna: On May 19, the AMA added two new COVID-19 administration codes and one new COVID-19 vaccine code to Appendix Q of CPT^® for use with the Moderna vaccine for children ages 6 months through 5 years. The vaccine is awaiting FDA approval at the time of going to press, but once it passes and the CDC issues its recommendations, you’ll use the following codes:

• Vaccine: 91311 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use.)
• Administration: 0111A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage; first dose)
• 0112A (… second dose)

There are no Moderna vaccines for children between the ages of 5 to 17 at this time. Consequently, there are no corresponding vaccine or administration codes.

Johnson & Johnson/Janssen: As of May 6, the Johnson & Johnson/Janssen vaccine “has been granted an Emergency Use Authorization (EUA) by the U.S. Food and Drug

Administration (FDA),” but “has not been approved or licensed by FDA” (https://www.janssenmd.com/janssen-covid19-vaccine/special-populations/pediatrics/use-of-janssen-covid19- vaccine-in-pediatric-participants). The AMA has yet to assign CPT^® codes for the Johnson & Johnson/Janssen vaccine or its administration to patients younger than 18.

Keep up to date: You can find all the current COVID-19 CPT^® codes by going to https://www.ama-assn.org/system/ files/covid-19-immunizations-appendix-q-table.pdf/.

You can find updates to the FDA COVID-19 vaccine approval process by going to https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/ covid-19-vaccines.

And you can find CDC recommendations for vaccine administration by going to https://www.cdc.gov/ coronavirus/2019-ncov/vaccines/stay-up-to-date.html#about-vaccines.