An Oncoming Wave of 70+ Coding Revisions Is Approaching.
Starting from November 1st, the American Medical Association is eliminating nearly all of the COVID-19 vaccine-related CPT® codes that were developed over the past several years. Instead, there will be a more concise set of product codes and a solitary administration code to replace them.
What is the Reason Behind the Changes in the COVID-19 Codes?
As per the CPT® Assistant Special Edition: August Update, the Food and Drug Administration (FDA) has recently advised a transition to monovalent COVID-19 vaccines for the 2023-2024 vaccine season. “Monovalent” denotes that these vaccines are designed to target a single strain of the virus. The freshly introduced codes will be applicable to these new vaccine variants.
Moreover, the updates also aim to simplify the coding system related to COVID-19 vaccines. Since COVID-19 vaccinations are expected to undergo annual modifications (similar to the updates seen with flu shots), the codes need to be adaptable to these yearly changes. Additionally, considering that the public health emergency concluded in May 2023, the codes no longer necessitate the same level of detail for tracking purposes.
What do the Newly Introduced COVID-19 Codes Encompass?
Upon receiving approval or emergency use authorization from the FDA, the new codes will take effect. The initial three codes are specifically intended for Pfizer vaccines, as outlined in CPT® Assistant. These codes are distinguished by their respective dosages:
- 91318: Vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mRNA-LNP, spike protein, with a dosage of 3 mcg/0.2 mL, formulated with tris-sucrose, designed for intramuscular use.
- 91319: Vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mRNA-LNP, spike protein, with a dosage of 10 mcg/0.2 mL, formulated with tris-sucrose, designed for intramuscular use.
- 91320: Vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mRNA-LNP, spike protein, with a dosage of 30 mcg/0.3 mL, formulated with tris-sucrose, designed for intramuscular use.
For products from Moderna, the following codes apply, with the dosage being the criterion for selection:
- 91321: Vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mRNA-LNP, with a dosage of 25 mcg/0.25 mL, designed for intramuscular use.
- 91322: Vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), mRNA-LNP, with a dosage of 50 mcg/0.5 mL, designed for intramuscular use.
To document the administration of these vaccine products, a solitary new code is designated: 90480. This code corresponds to the immunization administration through intramuscular injection of the single-dose COVID-19 vaccine. Importantly, similar to the preceding COVID-19 vaccine administration codes, code 90480 encompasses counseling, negating the requirement to separately report counseling, as instructed by CPT® Assistant.
Ensure not to Overlook a single Revised Code
As a component of this extensive code update, the descriptor for the Novavax product code has undergone a change – specifically, the term “preservative-free” has been removed. Consequently, the revised code now appears as follows: 91304 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, intended for intramuscular use.
This modification took effect on August 14, 2023. Notably, this code will remain operational even following the deletions detailed in the section below. Once the new administration code, 90480, becomes effective, you will pair it with code 91304.
In order to accommodate this more straightforward code structure, CPT® is eliminating numerous COVID-19 supply and administration codes. This development isn’t entirely unexpected, as there was a prior announcement indicating the anticipated removal of numerous codes. These codes were primarily applicable to vaccines that are no longer authorized for use in the United States.
Bid Farewell to a total of 64 Codes along with Appendix Q.
These deletions will take effect on November 1, 2023, and encompass the following codes:
• Admin: Ranging from 0001A to 0004A, 0011A to 0013A, 0021A, 0022A, 0031A, 0034A, 0041A, 0042A, 0044A, 0051A to 0054A, 0064A, 0071A to 0074A, 0081A to 0083A, 0091A to 0094A, 0104A, 0111A to 0113A, 0121A, 0124A, 0134A, 0141A, 0142A, 0144A, 0151A, 0154A, 0164A, 0171A to 0174A.
• Product: Ranging from 91300 to 91303, 91305 to 91317.
Due to these comprehensive changes, CPT® Appendix Q, which contains COVID-19 vaccine codes and related information such as vaccine manufacturers, product names, and national drug codes, will also be discontinued from November 1, 2023. The timing of this announcement implies that many 2024 CPT® code books will still include the codes that are slated for deletion and may not yet include the newly introduced codes. Therefore, it’s essential to ensure the accurate use of codes based on the date of service when coding encounters.