AMA Announces Update to COVID-19 Vaccine CPT Codes

The American Medical Association (AMA) recently announced 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 in advance 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:

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:

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.

Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel that collects broad input from the health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care system. This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology so it can fulfill its vital role as the trusted language of medicine today and the code to its future.

Source: American Medical Association