FDA Approves Updated COVID-19 Vaccines And Introduces New CPT Codes 2023-24

The FDA authorized the emergency use of the modified Moderna and Pfizer-BioNTech COVID-19 vaccines on September 11, 2023. These most recent formulations are designed to more efficiently target the variations that are already in circulation in an effort to strengthen defenses against serious COVID-19 outcomes, like hospital stays and fatalities. Interestingly, a monovalent component created especially to fight the Omicron strain XBB.1.5 is now included in the vaccinations. It is highly advised by the CDC that anybody six months of age and older get this updated immunization.

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FDA Approves Updated COVID-19 Vaccines

Introduction of Six New CPT Codes for COVID-19 Vaccine Administration

Six new CPT codes have been added along with the introduction of these revised vaccines, and they will take effect on September 11, 2023. Healthcare practitioners must be aware of these codes in order to properly bill and administer patient care:

CPT/HCPCS	Short Descriptor	Labeler Name	Vaccine/Procedure Name	Medicare Fee 2023-24
90480	ADMN SARSCOV2 VACC 1 DOSE	N/A	N/A	$40.00
91318	SARSCOV2 VAC 3MCG TRS-SUC	Pfizer-BioNTech	Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Yellow Cap)	$65.36
91319	SARSCV2 VAC 10MCG TRS-SUC IM	Pfizer-BioNTech	Pfizer-BioNTech COVID-19 Vaccine 2023-2024 Formula (Blue Cap)	$87.78
91320	SARSCV2 VAC 30MCG TRS-SUC IM	Pfizer-BioNTech	COMIRNATY (COVID-19 Vaccine, mRNA) 2023-2024 Formula	$131.10
91321	SARSCOV2 VAC 25 MCG/.25ML IM	Moderna	Moderna COVID-19 Vaccine 2023-2024 Formula	$145.92
91322	SARSCOV2 VAC 50 MCG/0.5ML IM	Moderna	SPIKEVAX 2023-2024 Formula	$145.92

It’s important to note that the federal government is not purchasing these vaccines. Instead, Medicare Part B covers both the vaccine and its administration under its standard payment policy. For the most updated billing codes, payment allowances, and their effective dates, providers are encouraged to consult the current list.

Changes in Medicare Coverage for Previous CPT Codes

As of September 12, 2023, Medicare no longer covers several previous CPT codes for COVID-19 vaccines. The affected codes include:

91312, 91313, 91314, 91315, 91316, 91317, 0121A, 0124A, 0134A, 0141A, 0142A, 0144A, 0151A, 0154A, 0164A, 0171A, 0172A, 0173A, and 0174A

Frequently Asked Questions (FAQ):

What is the new CPT code for COVID-19?

The CPT codes for COVID-19 testing can vary depending on the type of test. For example, CPT code 87635 is used for SARS-CoV-2 RNA detection.

What is the CPT code for COVID vaccine counseling?

COVID-19 vaccination counseling is normally included as part of the vaccination administration code. For vaccinations for children, advice by a doctor or other qualified health well-qualified could be identified separately together with codes such as 90460.

The administration of pediatric immunizations with the counseling code is:

Code	Description	Age Limit	Notes
90460	Immunization administration through any route, with counseling by a physician or other qualified health care professional, per vaccine or toxoid	Until age 18	The primary or sole element of every vaccine or toxoid administered
90461	Every additional vaccine or toxoid component administered	Until age 18	Listed separately, separate from the primary procedure code

New Vaccine Stand-alone Counseling Codes:

Code	Description	Duration	Age	Special Notes
G0310	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service	5 to 15 mins	All ages	Used for Medicaid billing purposes
G0311	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service	16 to 30 mins	All ages	Used for Medicaid billing purposes
G0312	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service	5 to 15 mins	Under 21	Used for Medicaid billing purposes
G0313	Immunization counseling by a physician or other qualified health care professional when the vaccine(s) is not administered on the same date of service	16 to 30 mins	Under 21	Used for Medicaid billing purposes
G0314	Immunization counseling by a physician or other qualified health care professional for COVID-19	16 to 30 mins	Under 21	Used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit (EPSDT)
G0315	Immunization counseling by a physician or other qualified health care professional for COVID-19	5 to 15 mins	Under 21	Used for the Medicaid Early and Periodic Screening, Diagnostic, and Treatment Benefit (EPSDT)

What is the CPT code for the Moderna COVID vaccine for ages 6 months to 5 years?

The COVID-19 vaccination Moderna is a vaccine for children between 6 months and 5 years old. This vaccine’s CPT code is 91311. This is the vaccine dose at 25 mcg/0.25 milliliters. The code for administration is 0111A for the initial dose and 0112A for the subsequent dose.

What is CPT code 90380 and 90381?

CPT code 90380 means “Immune globulin (Rh0[D]), human, for intramuscular use.” This code is employed to indicate when Rh0(D) immune globulin has been given to a person, usually to stop Rh immunization. It is typically employed in situations such as pregnancy when the mother is Rh negative and the unborn child is or could be Rh-positive to protect her immune system attacking the baby’s blood red cells. The CPT number 90381 on contrary, refers to “Immune globulin, anti-Rh(D), human, for intravenous use.” This code is utilized to administer intravenously Rh immunoglobulin. It has a similar function to the intramuscular counterpart, however it is administered directly into the vein. Both are used to stop Rh sensitization, which could cause hemolytic diseases in the infant in subsequent pregnancy.

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