Primary Care Coding Alert

News You Can Use:

Get Ready for Easier COVID-19 Vax Coding

Published on Fri Sep 15, 2023

Also: check out new guidance on Appendix Q.

CPT^®has created new codes for reporting COVID-19 vaccines, but this time, the updates effectively consolidate the over 50 previous COVID-19 immunization codes. To further simplify reporting, CPT^®will also delete all previously approved COVID-19 vaccine product and vaccine administration codes, with the exception of product code 91304 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use) from the code set effective Nov. 1, 2023.

Background: The Food and Drug Administration (FDA) recently recommended a shift to a monovalent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 vaccine that targets the predominant XBB lineage virus strain for the 2023-2024 vaccine administration season. As a response, CPT^®approved new monovalent COVID-19 vaccine product codes for Pfizer and Moderna vaccines, which the Food and Drug Administration (FDA) approved for emergency use on Sept. 11, 2023. CPT^®also approved a new administration code for use with any COVID-19 vaccine for all age-ranges, which will replace all previous product-specific vaccine administration codes.

Here’s what you need to know to code your provider’s COVID vaccine services as we move into the winter season.

Meet The New Codes

Pfizer: The following codes have been approved for Pfizer’s new monovalent vaccine products:

91318 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.3 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use) – 6 months through 4 years
91319 (… 10 mcg/0.3 mL dosage, tris-sucrose formulation…) – 5 years through 11 years
91320 (… 30 mcg/0.3 mL dosage, tris-sucrose formulation…) – 12 years and older

Moderna: The following codes have been approved for Moderna’s new monovalent vaccine products:

91321 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use) – 6 months through 11 years
91322 (… 50 mcg/0.5 mL dosage…) – 12 years and older

Administration: The following code is to be used with all COVID-19 vaccine product codes:

90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose)

Like the previous vaccine administration codes, counseling is bundled with 90480, so be sure not to 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.

“Also remember that if your physician performs a significant, separately identifiable evaluation and management (E/M) service at the same encounter, that E/M service should also be reported with modifier 25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) appended to the appropriate E/M code,” says Kent Moore, Senior Manager, Payment Strategies at the American Academy of Family Physicians. “It’s not uncommon for patients to be immunized during an encounter unrelated to the immunization. No part of the encounter, either the E/M or the immunization, should be neglected when filing a claim,” Moore adds.

Say Goodbye to All But One Previous Admin Code

As previously mentioned, CPT^®is deleting all previously approved COVID-19 vaccine product and vaccine administration codes, effective Nov. 1, 2023. The one exception is 91304, which represents the Novavax vaccine product, which will continue to be available for use. While administration codes for the Novavax product are slated for deletion, you will need to continue to use them until 90480 becomes effective. That will happen when the new products receive emergency use authorization or approval from the FDA. Once effective, it should be the only admin code used for the administration of that vaccine.

Note: CPT^®revised the parenthetical note for code 91304 to reflect this change.

Start Ignoring Appendix Q

Because of this code consolidation, Appendix Q, which was created to house the specific codes for COVID-19 vaccines, is also queued up for deletion 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 (https://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 codebook. Therefore, all the deleted codes, including Appendix Q, will still appear 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 expiration of the public health emergency (PHE) in May 2023, 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.

Read more: Find more guidance from the Centers for Disease Control and Prevention (CDC) regarding which patients should receive a COVID-19 vaccine here: www.cdc.gov/ coronavirus/2019-ncov/vaccines/different-vaccines/overview- COVID-19-vaccines.html.