The Food and Drug Administration’s (FDA) took action in the month of August 2021 to authorize an additional dose of COVID-19 vaccine for immunocompromised individuals, referred to as a “COVID Booster”. Both Pfizer and Moderna have been approved for this the third COVID-19 vaccine.

Administration of the COVID-19 booster will first be provided to those with immunocompromising conditions. It is anticipated that other population groups will be provided the booster vaccine in the fall.

The American Medical Association has published new Current Procedure Terminology (CPT) code for the third dose of the Pfizer COVID-19 vaccine, code 003A. Also published is a third dose of Moderna’s vaccine, and it is code 0013A. Use the following link to access the AMA information: AMA announces CPT code set ready for third doses of COVID-19 vaccines | American Medical Association (ama-assn.org)

The CPT codes and long descriptors assigned to third dose administration of the current Pfizer and Moderna COVID-19 vaccines are:

Pfizer

0003A – 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; third dose

Moderna

0013A – 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, 100 mcg/0.5 mL dosage; third dose

Per the Centers for Medicare and Medicaid Services (CMS):

Medicare would pay for administering an additional dose of COVID-19 vaccines consistent with the modified FDA emergency use authorization (EUA) that was announced today.

For COVID-19 vaccines administered on or after March 15, 2021, the national average payment rate for physicians, hospitals, pharmacies, and many other immunizers is $40 to administer each dose of a COVID-19 vaccine. The Medicare program would continue to pay providers $40 to administer this additional dose – the same amount as paid for other doses of the COVID-19 vaccine. 

Go to the following link to read over the CMS announcement: People With Medicare Who Are Immunocompromised Would be Able to Receive an Additional COVID-19 Dose At No Cost | CMS

The Centers for Disease Control and Prevention (CDC), has stated that:

The COVID-10 vaccines are working very well to prevent severe illness, hospitalization, and death, even against the widely circulating Delta variant. However, with the Delta variant, public health experts are starting to see reduced protection against mild and moderate disease. For that reason, the U.S. Department of Health and Human Services (HHS) is planning for a booster shot so vaccinated people maintain protection over the coming months.

HIM Coding Professionals need to remember: CPT (HCPCS Level I) codes describe outpatient services and procedures; and providers generally use HCPCS (Level II) codes for equipment, drugs, and supplies for services and treatment.

Be sure to stay on top of the healthcare revenue cycle in relation to COVID-19 documentation, coding, and billing. It’s always a good idea to conduct a focused audit of the COVID-19 related encounters, including those for the purpose of a vaccination. Both ICD-10-CM and CPT codes need to be accurate in order to remain in compliance.

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

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