The American Medical Association (AMA) has announced an editorial update to its Current Procedural Terminology (CPT) code set to include eight new codes for the bivalent COVID-19 vaccine doses from Moderna and Pfizer-BioNTech.
The US Food and Drug Administration (FDA) amended the emergency use authorizations for both Moderna’s and Pfizer-BioNTech’s vaccines to authorize bivalent formulations to be given as a single booster dose at least two months following primary or booster vaccination. The bivalent vaccines contain two messenger RNA components: one for the original COVID-19 strain and the other for the more common BA.4 and BA.5 subvariants of the now-dominant omicron strain.
The same day as the FDA’s announcement, AMA released the new CPT codes for the bivalent COVID-19 booster doses so providers can document and bill for administering boosters as soon as the vaccine doses are available this fall.
The Advisory Committee on Immunization Practices must now review and approve the use of the bivalent COVID-19 vaccine doses. The Committee is scheduled to meet today. Previous approvals for original COVID-19 vaccines moved fairly quickly, taking just a couple of weeks, according to Johns Hopkins’ Bloomberg School of Public Health.
“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,” Resneck stated. “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.”
The new CPT codes include 91312, 91313, 0124A and 0134A, which are effective for use immediately following the FDA’s amendment of the emergency use authorization for Moderna’s new COVID-19 booster in people who are 18 years or older and Pfizer-BioNTech’s new COVID-19 booster in those who are 12 years or older.
The other four new CPT codes— 91314, 91315, 0144A and 0154A—will be effective for use when FDA authorizes Moderna’s new COVID-19 booster for children between the ages of 6 and 11 years and Pfizer-BioNTech’s new COVID-19 booster for children between 5 and 11 years.
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Codes and descriptions for the CPT codes for the Moderna bivalent boosters for adults are as follows:
- 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
Codes and descriptions for the CPT codes for the Moderna bivalent boosters for children are:
- 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
For Pfizer-BioNTech’s bivalent booster in individuals 12 years or older, the CPT codes and descriptions are:
- 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
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For children who receive Pfizer-BioNTech’s bivalent COVID-19 boosters, the CPT codes and descriptions are:
- 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
References:
https://revcycleintelligence.com/news/8-new-cpt-codes-added-for-bivalent-covid-19-booster-doses