Industry Insight

AMA Announces Update to COVID-19 Vaccine CPT Codes

The American Medical Association (AMA) announces that the CPT code set has been updated by the CPT Editorial Panel to include vaccine and administration codes that are unique to a new formulation of the COVID-19 vaccine developed by Pfizer. The new formulation is based on a tris-sucrose buffer rather than the phosphate buffer present in the original formulation.

The provisional CPT codes will be effective for use on the condition that tris-sucrose formulation of Pfizer’s COVID-19 vaccine receives approval or emergency use authorization from the FDA. The AMA is publishing the CPT code update now to ensure electronic systems across the US health care system are prepared for the potential FDA approval or authorization of the tris-sucrose formulation of Pfizer’s COVID-19 vaccine.

The development of vaccine-specific CPT codes has clinically distinguished each coronavirus vaccine and dosing schedule for better tracking, reporting and analysis that supports data-driven planning and allocation. COVID-19 vaccines from AstraZeneca, Janssen (Johnson & Johnson), Moderna, Novavax, and Pfizer’s original formulation have previously been issued unique CPT codes.

To help ensure accurate coding and reporting of COVID-19 vaccines and immunization services, the AMA offers a vaccine code finder resource to help identify the appropriate CPT code combination for the type and dose of COVID-19 vaccine provided to each patient.

For quick reference, the new vaccine and administration codes assigned to the tris-sucrose formulation of Pfizer’s COVID-19 vaccine are as follows:

Pfizer vaccine code (tris-sucrose formulation)
91305, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use

Pfizer administration codes (tris-sucrose formulation)
0051A, 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose

0052A, 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; second dose

0053A, 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; third dose

In addition to the new vaccine-specific product CPT codes, the CPT Editorial Panel has approved provisional CPT codes for booster doses of COVID-19 vaccines created by Moderna and Pfizer. While the Pfizer booster is likely to remain the same dose as the existing formulation, the Moderna booster is likely to be delivered at a different dose from the existing formulation. For this reason, a new vaccine code was created for the Moderna booster vaccine. These provisional CPT codes will be effective for use on the condition that booster doses of the COVID-19 vaccines created by Moderna and Pfizer receive approval or authorization from the FDA.

For quick reference, the new vaccine and administration codes assigned to the tris-sucrose formulation of Pfizer’s COVID-19 vaccine are as follows:

Moderna booster code
91306, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use

Moderna booster administration code
0064A, 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/0.25 mL dosage, booster dose

Pfizer booster administration codes (original formulation and tris-sucrose)
0004A, 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, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose

0054A, 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose

Short, medium, and long descriptors for all the new vaccine-specific CPT codes can be accessed on the AMA website, along with other recent modifications to the CPT code set that have helped streamline the public health response to the SARS-CoV-2 virus and the COVID-19 disease.

— Source: American Medical Association

AHDI Announces New Board Members, 2021–2022 Executive Committee

The Association for Healthcare Documentation Integrity (AHDI) announces the addition of three new members and one reelected member to the Board of Directors, who will serve under the leadership of incoming president Stacy Lehto, CHDS, AHDI-F. The Board of Directors also announced officers for 2021–2022.

The following individuals were elected by the AHDI membership in June and will serve three-year Board terms from September 1, 2021, to August 31, 2024: Laura Bryan, MS, MT(ASCP), CHDS, AHDI-F; Mandy Hildenbrand, CHDS, AHDI-F; Patricia King, CHDS, AHDI-F (reelected); Deb Palmer, CHDS; and Valerie Purdy, CHDS, AHDI-F.

On August 2, 2021, the Board of Directors elected the following individuals to serve as officers for 2021–2022, taking office September 1, 2021: Jody Gall, RHDS, AHDI-F, secretary; Patricia King, CHDS, AHDI-F, treasurer; and Tina Hincka, RHDS, AHDI-F, president-elect.

AHDI recognizes and expresses gratitude to outgoing president Bonnie Monico, CHDS, AHDI-F, who will begin her term as immediate past president, and the following board members whose terms ended August 31, 2021: Sheila Guston, CHDS, AHDI-F; Cyndi Sandusky, CHDS, AHDI-F; Daysha Weller, RHDS, AHDI-F; and Brenda Wynn, RHIT, CHWP, CMT, AHDI-F.

“Bonnie Monico set out to build bridges when she started her second term as AHDI president,” says Guston, interim CEO of AHDI. “It was Bonnie’s mission to connect with members on a more personal level, and she has done exactly that—building bridges between members, nonmembers, board, and staff, and between all those who interact with the patient’s medical record regardless of their specific role.

“As she transitions to immediate past president, we thank Bonnie for her time and expertise as well as her love and passion for this organization and its members. We wish to thank Cyndi Sandusky, Daysha Weller, and Brenda Wynn for their many contributions during their time on the Board of Directors also. Laura Bryan, Mandy Hildenbrand, Deb Palmer, and Val Purdy are welcome additions to the Board, as is the return of Patt King for a second term. We are very grateful for their willingness to serve and to continue the important work ahead. The future is bright.”

Lehto states, “I am so honored to serve as president of AHDI in the coming year and look forward to continuing the great work begun by the administrations before me, especially the member community outreach. Survey feedback will guide many decisions in the year ahead, and I am delighted to work with AHDI Board, staff, and volunteers to achieve our goals. We could not succeed without them. Lastly, thank you to all who helped make HDIVC21 successful. It was truly amazing.”

— Source: Association for Healthcare Documentation Integrity

ChrysCapital-Backed GeBBS Healthcare Acquires Aviacode

GeBBS Healthcare Solutions, a provider of technology-enabled revenue cycle management (RCM) and risk adjustment solutions for health care providers and payers, recently announced the acquisition of Aviacode, a Salt Lake City–based provider of medical coding and compliance services to hospitals and physician groups.

The transaction expands the services, capabilities, and geographical footprints of both companies, enabling clients to benefit from an integrated RCM solution offering from one partner. This acquisition is part of GeBBS’ growth strategy, supported by the company’s investors, ChrysCapital. Aviacode clients will benefit from GeBBS’ end-to-end RCM services, workflow/automation tools, and large geographic footprint. Through this acquisition, GeBBS Healthcare will expand its US-based delivery capabilities and its medical coding/audit/clinical documentation improvement services portfolio.

“We continue to see strong market demand for our solutions as the challenging environment due to the pandemic has led providers to appreciate the value GeBBS can deliver as a strategic partner,” says Nitin Thakor, executive chairman of GeBBS Healthcare. “We view [mergers and acquisitions] to be a core component of our growth strategy. With the support of ChrysCapital, we will continue to acquire businesses with differentiated capabilities that have technology at the core of their value proposition.”

— Source: GeBBS Healthcare Solutions