What's Going on With the COVID Vaccines Now?
Date Posted: Monday,
May 15, 2023
Keeping up with the changes to the COVID vaccines has certainly been a rollercoaster ride, and we now have two new twists to this exciting ride. Twist one comes from the FDA who recently pulled the emergency use authorization (EUA) for the monovalent Moderna and Pfizer-BioNTech mRNA vaccines, and instead authorized the bivalent boosters for all doses starting at age 6 months. Twist two is found in the changes taking place as part of the official end to the COVID Public Health Emergency (PHE), beginning May 11, 2023. Buckle up, and let's look at how this changes things.
End of the Monovalent COVID-19 Vaccines
On Tuesday, April 18, 2023, the FDA announced the revision of the EUAs for the Moderna and Pfizer-BioNTech mRNA vaccines so that only a single dose of the bivalent form is now accepted as being fully vaccinated. "At this stage of the pandemic, data support simplifying the use of the authorized mRNA bivalent COVID-19 vaccines and the agency believes that this approach will help encourage future vaccination," said Peter Marks, M.D., Ph.D., director of the FDA's Center for Biologics Evaluation and Research.
On May 1, 2023, the AMA announced that retroactively (back to the date of the FDA announcement), the following codes are no longer authorized for use: 0001A, 0002A, 0003A, 0004A, 0011A, 0012A, 0013A, 0051A, 0052A, 0053A, 0054A, 0064A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 91300, 91301, 91305, 91306, 91307, 91308, 91309, and 91311. That's a pretty big change.
Officially, these codes are not being removed (deleted) from the CPT code set at this time; however, some of the guidelines have been revised to reflect these changes.
Vaccines and the End of the PHE
So, what does this mean for coverage of the COVID vaccines? An announcement by HHS stated that "Vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are a preventive health service for most private insurance plans and will be fully covered without a co-pay. Currently, COVID-19 vaccinations are covered under Medicare Part B without cost sharing, and this will continue. Medicaid will continue to cover all COVID-19 vaccinations without a co-pay or cost sharing through September 30, 2024, and will cover ACIP-recommended vaccines for most beneficiaries thereafter."
According to the Department of Labor, "While many plans must continue to cover COVID-19 vaccines at no cost to employees from an in-network provider, the requirement to cover COVID-19 vaccines out-of-network will generally lapse after the end of the COVID-19 public health emergency."
By Wyn Staheli, Director of Content - innoviHealth
Wyn Staheli is the Director of Content Research for innovHealth. She has over 30 years of experience in the healthcare industry. With her degree in Management Information Systems (MIS), she has been a programmer for a large insurance carrier, as well as a California hospital system. She is also the author and editor of many medical resource books and the founder of InstaCode Institute.
Find-A-Code is a product of innoviHealth Systems, Inc. FindACode.com is an online database of medical billing codes and information. People use Find-A-Code to assign codes to medical diagnoses and procedures in order to be reimbursed by insurance companies and Medicare. FindACode.com is a quick and easy system that uses a simple search to return accurate information. Rather than searching through 10 or more books, Find-A-Code has combined the information into one simple search.
