AMA Announces CPT Update for COVID-19 Boosters Adapted to Omicron

Aug 31, 2022 at 03:21 pm by pj



New codes assigned to bivalent COVID-19 vaccine booster doses from Moderna and Pfizer-BioNTech


The American Medical Association (AMA) has announced an editorial update to Current Procedural Terminology (CPT)®, the nation’s leading medical terminology code set for describing health care procedures and services, that includes eight new codes for the bivalent COVID-19 vaccine booster doses from Moderna and Pfizer-BioNTech. The updated boosters are adapted for the BA.4 and BA.5 Omicron subvariants and the original coronavirus strain in a single dose.

Four of the eight CPT codes (91312, 91313, 0124A and 0134A) are effective for use immediately as the U.S. Food and Drug Administration (FDA) has authorized Moderna’s new COVID-19 booster in individuals 18 years of age and older and Pfizer-BioNTech’s new COVID-19 booster in individuals 12 years of age and older. Four CPT codes (91314, 91315, 0144A and 0154A) will be effective for use on the condition that the FDA authorizes Moderna’s new COVID-19 booster in individuals 6 years through 11 years of age and Pfizer-BioNTech’s new COVID-19 booster in individuals 5 years through 11 years of age.


“Across the nation, 108 million Americans -- or more than half of those eligible to be boosted -- have yet to receive their first booster dose despite evidence that they are safe and highly effective against severe disease outcomes,” said AMA President Jack Resneck Jr., M.D. “The American Medical Association looks forward to the tomorrow’s review of the redesigned COVID-19 boosters by Advisory Committee on Immunization Practices and its pending recommendations on clinical uses for each product. As we prepare for potential fall and winter surges of COVID-19, the AMA encourages all who are eligible to get a booster and review the available options with a physician."

CPT codes distinguish the type and dose of a COVID-19 vaccine and booster provided to each patient and allows for data-driven reporting and analysis that supports effective monitoring of vaccine administration, vaccine safety, as well as other critical aspects of the public health response to the COVID-19 pandemic.

For quick reference, the new product and administrate codes assigned to each bivalent COVID-19 vaccine booster are:

Moderna bivalent booster – 18 years and older

91313     Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use

0134A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose

 

Moderna bivalent booster - 6 years through 11 years

91314     Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use

 

0144A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRN-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, booster dose

 

Pfizer-BioNTech bivalent booster - 12 years and older

91312     Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use

 

0124A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose

 

Pfizer-BioNTech bivalent booster - 5 years through 11 years

91315     Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use

 

0154A    Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose


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.

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.

Sections: Orlando Regulatory





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