Primary Care Coding Alert

Question: Which administration code should I be using for the third/booster dose of the Pfizer-BioNTech tris-sucrose vaccine? Should I be using 0054A or 0073A?

New Jersey Subscriber

Answer: For patients 5 through 11 years old, you should use 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) to report the vaccine. The corresponding administration codes are 0071A (… first dose), 0072A (… second dose), and 0073A (… third dose).

For patients 11 and up, you should use 91305 (… [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, trissucrose formulation, for intramuscular use) for the vaccine. The corresponding administration codes are 0051A (Immunization administration by intramuscular injection of … [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose), 0052A (… second dose), 0053A (… third dose), and 0054A (… booster dose).

A close look at the code descriptors for 0054A and 0073A tells you that the two codes are to be used with different strengths of the vaccine, with 0054A being used for administration of the 30 mcg/0.3 mL dose of the vaccine, and 0073A for the administration of the 10 mcg/0.2 mL dose. You should reserve use of the 10 mcg/0.2 mL dose and associated product and administration codes for “patients ages 5 through 11 years of age,” per CPT^® Assistant Special Edition October Update, Volume 31, 2021

(www.ama-assn.org/system/files/cpt-assistant-guide-coronavirus-october-2021.pdf).