AMA Updates CPT Codes for COVID-19 Vaccines

The American Medical Association (AMA) has announced updates to the Current Procedural Terminology (CPT) code set to account for changes to COVID-19 vaccines, including booster shots expected to rollout later this month.

The updates also include unique CPT codes for the vaccine and administration of a new formulation of the COVID-19 vaccine developed by Pfizer. The new formulation uses a tris-sucrose buffer instead of the phosphate buffer used in the original formulation, AMA explained. Therefore, the Association developed CPT codes:

• 91305: 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
• 0051A: 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose
• 0052A: 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; second dose
• 0053A: 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; third dose

The codes are for the use of the tris-sucrose formulation of Pfizer’s vaccine once it received emergency use authorization or full approval from the Food and Drug Administration (FDA).

FDA has already granted Pfizer’s original formulation full approval and has authorized the emergency use authorization for the vaccine to include a third dose, or booster shot. The White House plans to rollout a third dose of the Pfizer COVID-19 vaccine by Sept. 20. CPT code 0053A will be available to document the booster shots for the new formulation of Pfizer’s vaccine.

Booster shots for the other mRNA-based vaccine from biotechnology company Moderna are also expected, but later than the third doses of Pfizer, according to national new sources.

Moderna’s COVID-19 vaccine has yet to receive full FDA approval for its COVID-19 vaccine. However, FDA has altered the emergency use authorization to allow for a third dose of the vaccine. President Biden’s Chief Medical Adviser Anthony Fauci said over the weekend that Moderna has not submitted data on the efficacy of a booster shot, which Pfizer already has. As a result, the White House will unlikely rollout booster shots for both vaccines at the same time.

If the third dose of Modern’s COVID-19 vaccine is authorized by the FDA, then immunizers will have CPT codes to document those doses. In preparation for booster shots, AMA announced CPT codes:

• 91306: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use
• 0064A: 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, 50 mcg/0.25 mL dosage, booster dose

AMA noted that, unlike the Pfizer booster dose, the booster dose of Moderna’s vaccine is likely to be administered at a different dose from the existing formulation.

“For this reason, a new vaccine code was created for the Moderna booster vaccine. These provisional CPT codes will be effective for use on the condition that booster doses of the COVID-19 vaccines created by Moderna and Pfizer receive approval or authorization from the FDA,” the Association stated in the announcement.

The updated CPT code set also includes:

• 0004A: 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, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose
• 0054A: 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose

Short, medium, and long descriptors for all the new COVID-19 vaccine CPT codes are available on AMA’s website. Providers can also access other pandemic-related modifications to the CPT code set using that link.