CPT Code Set Ready for Third Doses of COVID-19 Vaccines

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New Current Procedural Terminology (CPT®) codes have been created that streamline the novel coronavirus testing currently available on the United States market. These CPT codes are unique for each coronavirus vaccine as well as administration codes unique to each such vaccine. The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting and analysis that supports data-driven planning and allocation. 

Among these is a new code to describe the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment or procedural services during a public health emergency. 

Summary of the SARS-CoV-2 related CPT codes 

Review a summary of the SARS-CoV-2 related CPT codes that have been approved for the CPT code set. 

  • Aug. 16, 2021: Accepted addition of one administration code 0013A to report Moderna third dose. Appendix Q has been updated to reflect this addition. This code was published on Aug. 16, 2021 and this code (0013A) is effective for Emergency Use Authorization as of Aug. 12, 2021. 

  • July 30, 2021: Accepted addition of one administration code 0003A to report Pfizer-BioNTech third dose. Appendix Q has been updated to reflect this addition. This code was published on July 30, 2021 and this code (0003A) is effective for Emergency Use Authorization as of Aug. 12, 2021. 

  • May 4, 2021: Accepted addition of one Category I code to report SARS-CoV-2 vaccine and two immunization administration codes. Codes 91304, 0041A, 0042A are used to report the Novavax COVID-19 vaccine, Appendix Q has been updated to reflect these additions. These codes were published on May 4, 2021 and will be effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration. 

  • January 19, 2021: Accepted addition of one Category I code to report SARS-CoV-2 vaccine and immunization administration codes. Codes 91303, 0031A are used to report the Janssen COVID-19 vaccine, Appendix Q has been updated to reflect these additions. These codes were published on January 19, 2021 and will be effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration. 

  • December 17, 2020: Accepted addition of two Category I codes to report SARS-CoV-2 vaccine and immunization administration codes.  Codes 91302, 0021A and 0022A are used to report the AstraZeneca COVID-19 vaccine and updated Appendix Q to reflect these additions. These codes were published on December 17, 2020 and will be effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration. 

  • November 10, 2020: Accepted addition of codes addition of six Category I codes to report SARS-CoV-2 vaccine and immunization administration codes. Codes 91300, 0001A and 0002A are used to report the Pfizer-BioNTech. COVID-19 vaccine and 91301, 0011A and 0012A are used to report the Moderna COVID-19 vaccine. Also, new and revised guidelines, parenthetical notes, and a new Appendix Q were added. These codes were published on November 10, 2020 and will be effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration. 

  • Accepted addition of code 87428 for reporting multiplex viral pathogen panel using antigen immunoassay technique for SARS-CoV-2 testing along with influenza A and influenza B. 

  • Accepted addition of code 87636 for reporting combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B, code 87637 for combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B and RSV and 87811for antigen detection of SARS-CoV-2 by direct optical (i.e., visual) observation.  Two new PLA codes (0240U and 0241U) were accepted for detection of SARS-CoV-2, Influenza A and Influenza B; code 0241U also detects RSV. Additionally, Immunology guidelines were also revised, along with codes 87301, 87802 and their subsidiary codes. 

  • Accepted addition of code 99072 for the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency, as defined by law. In addition, one code, 86413, was created for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 

  • Aug. 10, 2020: Accepted addition of codes 86408 for reporting coronavirus 2 (SARS-CoV-2) neutralizing antibody screen and 86409 for reporting coronavirus 2 (SARS-CoV-2) neutralizing antibody titer. In addition, two new PLA codes (0225U and 0226U) were accepted for detection of SARS-CoV-2. These new codes are effective Aug. 10, 2020. 

  • Accepted addition of code 87426 to report infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2. In addition, two new PLA codes (0223U and 0224U) were accepted for detection of SARS-CoV-2. 

  • May 20, 2020: Accepted addition of PLA code 0202U to report the BioFire® Respiratory Panel 2.1 (RP2.1) test. The new code was effective May 20, 2020. 

  • April 10, 2020: Accepted revision of code 86318 to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328; addition of code 86328 to report single step antibody testing for severe acute respiratory syndrome coronavirus 2; addition of child code 86769 to report multiple-step antibody testing for severe acute respiratory syndrome coronavirus 2; and revision of the Immunology guidelines. The new codes and revision were effective April 10, 2020. 

  • March 13, 2020: Accepted addition of code 87635 to report infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]), amplified probe technique. The new code was effective March 13, 2020. 

Along with releasing the standard code descriptor PDF, we are also releasing an easy to use Excel file of just the SARS-CoV-2-related CPT codes. The file contains the SARS-CoV-2-related CPT codes released since the 2021 data file release on Aug. 31, 2020 and includes: 

  • CPT code descriptors (long, medium, and short) 

  • Published date 

  • Effective date 

  • Type of change.  

Visit the COVID-19 CPT vaccine and immunization codes page for more information and to download the files. 

As new SARS-CoV-2-related CPT codes are published by the CPT Editorial Panel, the American Medical Association (AMA) will update the file. 

Read the full article here.  

Full Ink: https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance 

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