November 20, 2020 | By Brenda Edwards, CPC, CDEO, CPB, CPC-I, CEMC, CRC, CMRS, CMCS
COVID-19 has been disrupting the healthcare environment for over a year now. Massive changes and evolutions have been introduced for how to code for services during COVID-19 including virtual visits, lab testing, and vaccinations. This article will cover COVID-19 vaccination codes.
Vaccinations
The American Medical Association (AMA) introduced the first vaccination codes in November 2020. As explained in the CPT® Assistant Special Edition: Vaccine Coding Development, a rapid development and establishment for new codes had been undertaken to quickly create a new vaccine structure to report COVID-19 vaccine candidates that were in varying stages of development. The structure for the vaccines is different than what is currently used and will allow for additions to the code set as new vaccines are added.
The new code set is specific to COVID-19 vaccine products. These codes are identified with the lightning bolt symbol until approval is received from the FDA. The vaccine codes are identified with codes 91300 – 91303; each code represents a specific vaccine product and have corresponding administration code(s), depending on the number of injections in the series.
|
Vaccine Code |
Description | Vaccination Name |
Administration Code |
| 91300 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use |
Pfizer-BioNTech |
0001A (1st dose) 0002A (2nd dose) |
| 91301 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use |
Moderna |
0011A (1st dose) 0012A (2nd dose) |
| 91302 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use |
AstraZeneca |
0021A (1st dose) 0022A (2nd dose) |
| 91303 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use | Janssen (Johnson & Johnson) |
0031A (single dose) |
The administration codes include risk and benefit counseling, when performed. Since the federal government is responsible for the initial purchase and distribution of the vaccines across the country, it would be inappropriate to bill for the vaccine; only the vaccine administration is billable.
The AMA and CMS are a wealth of information that should be continually monitored for changes on a routine basis. Click here for additional information from AMA or CMS.
