The American Medical Association (AMA) announced the addition to the Current Procedural terminology (CPT® ) code set of a new COVID-19 booster for the Janssen Pharmaceutical Companies of Johnson & Johnson vaccine. The October 27, 2021, AMA press release explains that this vaccine is added to the other booster vaccine doses from both Pfizer and Moderna.

The new CPT code assigned to the Janssen (J&J) COVID-19 vaccine booster approved by the CPT Editorial Advisory Panel is:

0034A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5 mL dosage; booster dose

The following is the link to the announcement: AMA announces CPT update to COVID-19 vaccine booster | American Medical Association (ama-assn.org)

The Pfizer booster has the following CPT code (original formulation and tris-sucrose):

0004A 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, 30 mcg/0.3 mL dosage, diluent reconstituted; booster dose

0054A 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, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose

The Moderna booster administration code is:

0064A 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, 50 mcg/0.25 mL dosage, booster dose

91306 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use
The AMA has a dedicated website area for the COVID-19 vaccine and immunization codes, so be sure to check that out: COVID-19 CPT vaccine and immunization codes | American Medical Association (ama-assn.org)

These AMA COVID-19 vaccine codes incorporate the specialized tracking needs of the Centers for Disease Control and Prevention (CDC) and Centers for Medicare & Medicaid Services (CMS) by identifying two code groups. One group identifies a specific vaccine product and the other provides a vaccine administration code that is both vaccine and dose specific. It is always important to select the code that has been created for that manufacturer’s vaccine to ensure compliant coding.

The AMA states that if you have questions on CPT coding and content should be directed to the CPT Network, the authoritative source for CPT coding answers. Also consult the AMA online library of COVID-19 CPT coding and guidance. In addition, the AMA CPT Assistant Special Edition: September Update contains good information and case examples for all coding staff to review. This can be found at: https://www.ama-assn.org/system/files/cpt-assistant-guide-coronavirus-september-2021.pdf

There certainly is a lot to keep up with in order to be accurate and compliant. Now is the time to be sure that your Chargemaster is updated correctly with the new CPT code(s) for the boosters. This includes updating any forms used for charging (i.e., office and clinic charge tickets) and inform your coding and billing staff of the additions as well. A best practice is to confirm that the new code(s) are applied correctly and moves electronically correctly onto the bill (claim). In addition, plan for a retrospective audit to be conducted in the near future, prior to years end would be best.

Reimbursement Management Consultants (RMC) can provide assistance with medical coding support, auditing, education, compliance consulting, and HCC/risk adjustment services. RMC is a woman-owned, US-based and operated company which specializes in a variety of medical coding and auditing services. Contact us here.

Written by Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA Approved ICD-10-CM/PCS Trainer