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AMA announces update to COVID-19 vaccine CPT codes


 

The American Medical Association (AMA) today announced that the Current Procedural Terminology (CPT®) code set has been updated by the CPT Editorial Panel to include vaccine and administration codes that are unique to the COVID-19 vaccine candidate under development by Novavax Inc.

The provisional CPT codes will be effective for use on the condition that the Novavax COVID-19 vaccine receives approval or emergency use authorization from 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. health care system are prepared in advance for the potential FDA approval or authorization of the Novavax COVID-19 vaccine.

"Relying on multiple manufacturers to produce different COVID-19 vaccine products helps to avoid possible supply disruptions and supports the needed volume of doses," said AMA President Susan R. Bailey, M.D. "However, accurately 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."

The Novavax COVID-19 vaccine joins other COVID-19 vaccines from AstraZeneca, Janssen (Johnson & Johnson), Moderna and Pfizer that were previously issued unique CPT codes to clinically distinguish each vaccine and immunization administration for better reporting and analysis that supports data-driven planning and allocation. To help ensure accurate coding and reporting of COVID-19 vaccines and immunization services, the AMA offers a code finder resource to help identify the appropriate CPT code combination for the type and dose of COVID-19 vaccine provided to each patient. The AMA's COVID-19 vaccine coder resource will be updated to include the new CPT codes created for the Novavax COVID-19 vaccine.

For quick reference, the Novavax COVID-19 vaccine has been assigned the following Category I CPT code and long descriptor:

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

In addition to the new vaccine-specific product CPT code, the Novavax COVID-19 vaccine has been issued a vaccine administration CPT code that is specific to its two-dose immunization schedule. This CPT code is used to report the actual work of administering the vaccine, in addition to all necessary counseling provided to patients or caregivers and updating the electronic record.

For quick reference, the Novavax COVID-19 vaccine has been assigned the following vaccine administration CPT codes and long descriptors:

0041A Immunization administration by intramuscular injection of 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; first dose

0042A Immunization administration by intramuscular injection of 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; second dose

Short, medium and long descriptors for all the new vaccine-specific CPT codes can be accessed on the AMA website, along with several 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 health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care 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.

 
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