AMA Announces CPT Update for COVID-19 Booster Candidates

The American Medical Association (AMA) today announced an editorial update to Current Procedural Terminology (CPT®), the nation's leading medical terminology code set for describing healthcare procedures and services, that includes newly assigned provisional CPT codes for COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline.

The Pfizer booster candidate is proposed for use in children ages 5 to 11 who have completed a COVID-19 vaccine primary series, while the Sanofi-GSK booster candidate is proposed for use in persons aged 18 and older who have completed a COVID-19 vaccine primary series.

Each provisional CPT code is effective for use on the condition that its assigned booster candidate is granted an Emergency Use Authorization by the U.S. Food and Drug Administration (FDA). The AMA is publishing the CPT code update now to ensure electronic systems across the U.S. healthcare system are prepared in advance for the potential FDA authorization.

"As the highly contagious Omicron BA.2 coronavirus subvariant is causing an increase in COVID-19 infections across the country, the American Medical Association continues to strongly urge every eligible individual to make sure they are up to date on their COVID-19 vaccinations, including booster doses," said AMA President Gerald E. Harmon, M.D. "To provide further protection, people aged 50 and older, as well as immunocompromised individuals aged 12 and older, may also consider getting a second booster dose at least 4 months after an initial booster dose. We urge patients to check the CDC's guidance on COVID-19 boosters and review the available options with a physician."  

CPT codes clinically distinguish each coronavirus vaccine and dosing schedule to allow for data-driven tracking, reporting, and analysis that supports planning and allocation during the public health response to the pandemic. To date, 35 CPT codes have been created for reporting COVID-19 vaccines. 

To help ensure accurate coding and reporting of COVID-19 vaccines and immunization services, the AMA offers a vaccine code finder resource to help identify the appropriate CPT code combination for the type and dose of COVID-19 vaccine provided to each patient.

For quick reference, the new product code and administration codes assigned to each COVID-19 booster candidate:

Product and Administration Codes for Sanofi-GSK Booster Candidate

91310 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, for intramuscular use

0104A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, booster dose

Administration Code for Pfizer Booster Candidate

0074A - 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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose

Conclusion

Short, medium, and long descriptors for all the new vaccine-specific CPT codes can be accessed on the AMA website, along with other recent modifications to the CPT code set that have helped streamline the public health response to the SARS-CoV-2 virus and the COVID-19 disease.

Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel that collects broad input from the healthcare community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern healthcare system. This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology so it can fulfill its vital role as the trusted language of medicine today and the code to its future.


Source: AMA