Based on recent recommendations made by the Food and Drug Administration (FDA) to shift to a monovalent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) vaccine that targets the predominant XBB lineage virus strain for the 2023-2024 vaccine administration season, the Current Procedural Terminology (CPT) Editorial Panel (the Panel) has approved new monovalent COVID-19 vaccine product codes for Pfizer and Moderna vaccines.

CPT Codes 91318, 91319, 91320 were approved for the new monovalent vaccine products from Pfizer, and CPT codes 91321 and 91322 were approved for the new monovalent vaccine products from Moderna. In addition, a new vaccine administration code (90480) was approved for reporting the administration of any COVID-19 vaccine for any patient (pediatric or adult), replacing all previously approved specific vaccine administration codes. The new vaccine product codes will become effective upon receiving approval from the FDA.

All previously approved COVID-19 vaccine product and vaccine administration codes will be deleted from the CPT code set effective November 1, 2023. The exception will be vaccine product code 91304, which represents the Novavax COVID-19 vaccine product, which will remain active.

Lastly, given that the COVID-19 vaccine product and vaccine administration codes have been streamlined, Appendix Q will also be deleted from the CPT code set effective November 1, 2023.

To assist CPT code users in differentiating and reporting the available vaccine product codes and the associated immunization administration codes appropriately, the American Medical Association (AMA) established a website (https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance) that features timely updates of the Panel’s actions. The last COVID-19 update was in the CPT Assistant Special Edition: May Update (2023) in which new vaccine administration codes for the Pfizer and Moderna bivalent vaccines were discussed.

This issue of CPT^® Assistant Special Edition provides guidance on the appropriate use of the new Pfizer and Moderna monovalent vaccine product codes with the new vaccine administration code based on these recent COVID-19 vaccine recommendations.

Table of Contents

Immunization Administration for Vaccines/Toxoids

90480 Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose

Vaccines, Toxoids

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, for intramuscular use

(Report 91304 with administration code 90480)

91318 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use

(Report 91318 with administration code 90480)

91319 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use

(Report 91319 with administration code 90480)

91320 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use

(Report 91320 with administration code 90480)

91321 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use

(Report 91321 with administration code 90480)

91322 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use

(Report 91322 with administration code 90480)

Recently, the Vaccines and Related Biological Products Advisory Committee (VRBPAC), an advisory group of the FDA, met to discuss which strain(s) of the COVID-19 virus should be included in a vaccine for the 2023-2024 vaccination season. The VRBPAC recommended that the COVID-19 vaccine for the 2023-2024 vaccination season be a monovalent vaccine that contains the XBB.1.5 strain. Pfizer and Moderna are currently updating their vaccine products to reflect this change.

Given the recommendation from the VRBPAC, which indicates switching COVID-19 vaccinations to annual updates (similar to influenza vaccinations) and the expiration of the public health emergency (PHE) in May 2023, there is no longer a need for the coding granularity of individual administration codes for every vaccine product. This makes it possible to revise the CPT COVID-19 vaccine product and vaccine administration code structure to align with the existing CPT vaccine product and vaccine administration codes. This alignment effort contains several parts. The first part is the approval of three new vaccine product codes for the Pfizer COVID-19 products and two new vaccine product codes for the Moderna COVID-19 products. The codes and their descriptors and associated age ranges are listed in Table 1 (Pfizer) and Table 2 (Moderna).

New Pfizer Vaccine Product Codes & Age Ranges

91318 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use (6 months through 4 years)

91319 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, tris-sucrose formulation, for intramuscular use (5 years through 11 years)

91320 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 (12 years and older)

New Moderna Vaccine Product Codes & Age Ranges

91321 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use (6 months through 11 years)

91322 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use (12 years and older)

The second part of the alignment process is the approval of a single COVID-19 vaccine administration code (90480) to be used with all COVID-19 vaccine product codes. As with previous, more granular COVID-19 vaccine administration codes, counseling is included in code 90480 and should not be reported separately. The physician or other qualified health care professional (QHP) should exercise clinical judgment to determine whether the administration of the vaccine product is appropriate for a given patient. More information on current guidance from the Centers for Disease Control and Prevention (CDC) regarding which patients should receive a COVID-19 vaccine is available at https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/overview-COVID-19-vaccines.html.

The following clinical examples and procedural descriptions reflect typical clinical scenarios for which these new codes would be appropriately reported.

Typical Patient (91304)

A 33-year-old individual seeks immunization against SARS-CoV-2 virus to decrease the risk of contracting this disease, consistent with evidence-supported guidelines. The individual is offered and accepts an intramuscular injection of the SARS-CoV-2 vaccine for this purpose.

Description of Procedure (91304)

The physician or other QHP determines that the SARS-CoV-2 vaccine is appropriate for this patient and dispenses the vaccine according to the dose scheduled in the administration code for the SARS-CoV-2 vaccine.

Typical Patient (91318)

A parent or guardian of a 1-year-old female seeks immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence supported guidelines. The parent or guardian is offered and agrees to an intramuscular injection of SARS-CoV-2 vaccine for the child for this purpose.

Description of Procedure (91318)

The physician or other qualified health care professional (QHP) determines that the SARS-CoV-2 vaccine is appropriate for this patient and dispenses the vaccine according to the dose scheduled in the administration code for the SARS-CoV-2 vaccine.

Typical Patient (91319)

A parent or guardian of a 7-year-old male seeks immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence-supported guidelines. The parent or guardian is offered and agrees to an intramuscular injection of SARS-CoV-2 vaccine for the child for this purpose.

Description of Procedure (91319)

Typical Patient (91320)

A 33-year-old female seeks immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence-supported guidelines. The individual is offered and accepts an intramuscular injection of SARS-CoV-2 vaccine for this purpose.

Description of Procedure (91320)

Typical Patient (91321)

A parent or guardian of a 1-year-old male seeks immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence supported guidelines. The parent or guardian is offered and agrees to an intramuscular injection of SARS-CoV-2 vaccine for the child for this purpose.

Description of Procedure (91321)

Typical Patient (91322)

Description of Procedure (91322)

Typical Patient (90480)

A 65-year-old female presents for possible immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence-supported guidelines. After counseling, she is offered and accepts an intramuscular injection of SARS-CoV-2 vaccine for this purpose.

Description of Procedure (90480)

It is confirmed that vaccination to decrease the risk of COVID-19 is indicated. Counseling of the patient, parent, or guardian on the benefits and risks of vaccination to decrease the risk of COVID-19 and obtain consent. Administer the dose of the COVID-19 vaccine by intramuscular injection. Monitor the patient for any adverse reaction. Update the patient’s immunization record (and registry when applicable) to reflect the vaccine administered.