We are all hearing and seeing news and information daily about the efforts to vaccinate the United States population against COVID-19 and progress is being made. With this medical effort there is a wealth of published guidance and facts that have been developed by the Centers for Medicare and Medicaid Services (CMS), the Centers for Disease Control and Prevention (CDC), and the American Medical Association (AMA) regarding the vaccination medical codes.

With the rapid release of specific COVID-19 vaccination provider guidance those in Revenue Cycle, HIM coding, and compliance need to gather all resources and tools together to have a clear understanding and ability to apply the use of these medical codes correctly.  The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) (Pub. L. 116-136)  is where you will find the Medicare Part B coverage and payment for Coronavirus Disease 2019 (COVID-19) vaccine and its administration.

CMS has information on the vaccine CPT/HCPCS codes to use for the Pfizer, Moderna, AstraZeneca and Janssen (Johnson&Johnson) products. In addition, CMS has CPT code information regarding the Monoclonal antibodies and administration from Eli Lily and Regeneron, along with a useful “toolkit” for providers to access.

There is also a reference document for State Medicaid, this is titled, “Coverage and Reimbursement of COVID-19 Vaccines, Vaccine Administration, and Cost Sharing under Medicaid, the Children’s Health Insurance Program, and Basic Health Program”. Within this document are instructions post-vaccination which state, “vaccine recipients must be provided with emergency use authorization (EUA) Fact Sheets on the vaccine and vaccination cards”.

The CDC is publishing daily statistics on the number of vaccinations that have been given. Overall US COVID-19 Vaccine Distribution and Administration; Maps, charts, and data are provided by the CDC.  Vaccines authorized for emergency use or approved for full use in the U.S.:

On a regular basis visit the American Medical Association website for updated vaccine and CPT information is needed. There are several hyperlinks to downloadable tools, including for the lab and vaccine administration.

The following table helps to navigate through the current vaccine codes (as of 2/1/2021).

 PfizerPfizerModernaModernaAstraZenecaAstraZenecaJanssen(J&J)
CPT91300913009130191301913029130291303
ModifierSLSLSLSLSLSLSL
CPT Admin0001A0002A0011A0012A0021A0022A0031A
Other16 yrs & older16 yrs & older18 yrs & older18 yrs & olderEffective upon EUAEffective upon EUAEffective upon EUA

Note that the CPT administration code is specific to each drug manufacturer and the dosage. Emergency Use Authorization or EUA continues as new drugs come on the market.

Make sure your facility/organization and/or clinic has the proper vaccine consents in place, proper forms (post-vaccine instructions) for each patient and they are completed. In addition, bring your privacy and security expert to check on the HIPAA aspects of your vaccination activities.

Your hospital/facility, clinic or physician practice will need to ensure that your Health Information Management (HIM) coding staff are fully educated and trained on the use of the COVID-19 vaccine CPT codes. Since these particular CPT codes are often auto-coded via the chargemaster (often called “Charge Description Master”), then there is  a need to include a review of that document/file as well.

In ICD-10-CM we have one code for vaccine encounter, titled: “Encounter for Immunization”, code Z23, so we need to validate that accuracy also. In addition, a best practice is to plan and conduct a thorough audit or review of the clinical documentation and coding quality for encounters in which the vaccine was administered.  For your vaccine coding education, review and auditing needs, RMC, is there to help you.

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

Reimbursement Management Consultants (RMC) can provide assistance with medical coding support, auditing, compliance and CDI. RMC is a Woman-owned, US-based, and operated company which specializes in a variety of medical coding compliance services. Click here for more information!