The American Medical Association (AMA) has updated its CPT code set to include new vaccine codes for the 2024-2025 influenza season, as well as for pneumonia and meningitis. These updates, including one code revision, will be reflected in the CPT 2025 publication, though some changes are already in effect.
Influenza Vaccine Code Updates
For the 2024-2025 flu season, the Centers for Disease Control and Prevention (CDC) has indicated that all flu vaccines will be trivalent, targeting H1N1, H3N2, and a B/Victoria lineage virus. Although Medicare payment allowances and effective dates for the 2024-2025 flu season are not yet published, two new influenza vaccine codes will be effective from July 1, 2024:
– 90637: Influenza virus vaccine, quadrivalent (qIRV), mRNA; 30 mcg/0.5 mL dosage, for intramuscular use
– 90638: Influenza virus vaccine, quadrivalent (qIRV), mRNA; 60 mcg/0.5 mL dosage, for intramuscular use
These vaccines are pending FDA approval.
Additionally, there is one revised code:
– 90661: Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic-free, 0.5 mL dosage, for intramuscular use.
This revised code descriptor will be effective from January 1, 2025.
New Vaccine Codes
For the 2025 CPT publication cycle, the following new vaccine codes have been accepted:
– 90684: Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use. This vaccine received FDA approval on June 20, 2024, and the code will be effective from June 17, 2024.
– 90624: Meningococcal pentavalent vaccine, Men B-4C recombinant proteins and outer membrane vesicle, and conjugated Men A, C, W, Y-diphtheria toxoid carrier, for intramuscular use. This code will be effective from October 1, 2024, with the vaccine pending FDA approval.
FDA Approval for RSV Vaccine
Moderna’s respiratory syncytial virus (RSV) vaccine received FDA approval on May 31. The CPT code 90683 for the respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use will be included in the CPT 2025 publication. According to the CDC, RSV-positive tests and hospitalizations remain low in the U.S., along with national vaccination coverage.
Update on Influenza Vaccine Code
On July 19, the AMA released a new CPT code:
– 90695: Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use. This code will be effective upon receiving emergency use authorization or approval from the FDA.
Reference:
https://www.ama-assn.org/system/files/vaccine-long-descriptors.pdf