What are CPT Codes?
Current Procedural Terminology codes are created, copyrighted, and maintained by the American Medical Association. This is a huge task, as health care practices are constantly shifting, requiring new codes to be created for new services and current codes to be revised or retired as needed. Thousands of codes are in use, and the AMA updates them annually.
A Breakdown of the Coronavirus Vaccines CPT Codes
On September 1, 2020, the AMA released the 2021 CPT code list, which went into effect on January 1 of this year. There was a total of 329 CPT code changes, including 206 code additions, 54 code deletions, and 69 code revisions. Among those added to the list were a unique CPT code for each of five coronavirus vaccines— those from Pfizer, Moderna, and Johnson & Johnson, which had at the time of release, received emergency use authorization from the FDA; and those made by AstraZeneca and Novavax, which at the time of release were still awaiting EUA— as well as administration codes unique to each such vaccine.
The CPT codes clinically distinguish each coronavirus vaccine from its fellows. This allows for better tracking, reporting, and analysis of the use and results of each vaccine, which will in turn enable data-driven planning and allocation. Making it easier for providers to update and track patients’ records will make it easier for
AMA President Susan R. Bailey, MD., said, “[A]ccurately correlating vaccinated patients with one of the available COVID-19 vaccines is critical for managing immunizations. This challenge is managed with unique CPT codes that clinically distinguish each COVID-19 vaccine and provide the needed informational precision to ensure optimal vaccine distribution and administration.”
For quick reference, the Category I CPT codes and long descriptors for the vaccine products are:
- 91300: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use.
- 91301: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use.
- 91302: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.
- 91303: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.
- 91304: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5mL dosage, for intramuscular use.
This level of specificity is a first for vaccine CPT codes, which offers the ability to track each vaccine dose, even when the vaccine is not reported in a claim (i.e., the dose was given to the patient for free). There are also administrative codes that accompany each CPT code to indicate dosage amount; this incorporates the specialized tracking needs of the CDC and CMS. The code group above identifies a specific vaccine product, and the other provides a vaccine administration code that is both vaccine and dose specific. It is important to select the code that has been created for that manufacturer’s vaccine.
In order to assist with this process, the AMA has put out a resource to assist you in finding the right CPT code combination for the type and dose of vaccine you are using. Visit their website https://www.ama-assn.org/find-covid-19-vaccine-codes to use the tool and find the right codes in minutes.