Limit this code to administration of the Pfizer-BioNTech vaccine.
On May 17, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to authorize the use of a booster dose for patients 5 through 11 years of age.
The CPT® code to report administration of this booster is 0074A 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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose. The American Medical Association (AMA) published this new code on its COVID-19 CPT vaccine and immunization codes site on April 26, 2022, noting that the code would be effective upon receiving EUA or approval from the FDA.
Pair 0074A With 91307
The COVID-19 vaccine supply code that applies to admin code 0074A is existing CPT® code 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.
Code 91307 is the same supply code that you use when reporting the first through third doses of the vaccine using 0071A to 0073A.
Keep Reporting Rules Straight
When your practice follows the various rules for reporting, you can expect payment for administration of COVID-19 vaccines from payers. But remember that the Centers for Medicare & Medicaid Services (CMS) anticipates that providers typically will not currently incur a cost for the supply of COVID-19 vaccine products and states, “Providers should not bill for the product if they received it for free.” Reporting and billing rules may vary for these codes, so be sure to check the payer’s policy.
For More Information: 85043 use 0074a for covid 19 pediatric booster