AMA Releases COVID-19 Vaccine Code for Janssen

A fourth COVID-19 vaccine code has been released by the American Medical Association’s CPT® Editorial Panel, along with a proprietary administration code.  

The AMA released on Jan. 19, 2021, CPT® code 91303 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/0.5mL dosage, for intramuscular use.

However, like the code for AstraZeneca, this code will not become effective until the Food and Drug Administration (FDA) issues the vaccine product emergency use authorization or approval. And Medicare claims processing systems will not accept 91303 until that happens.

When and if the FDA issues the Janssen COVID-19 vaccine EUA/approval, providers will report 91303 with new administration CPT® code 0031A 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/0.5mL dosage, single dose.

Note that Janssen is a single dose vaccine, requiring a single administration. Providers will not have any reason to report 0031A more than once for a patient in any given year. In a Special Edition: January Update of CPT® Assistant, the AMA provides coding guidance for these new additions to the CPT® vaccine and administration code collection.

Note: The FDA released new guidelines on May 5, 2022, for this COVID-19 vaccine.

The AMA has also released an update to Appendix Q in CPT®, which includes the vaccine’s National Drug Code: NDC 10/11 labeler product ID 59676-580-05/59676-0580-05.

5 New Medicine Codes for July 1

The CPT® Editorial Panel also released early an additional five new codes in the Medicine/Vaccine, Toxoids section of the AMA’s CPT®. The following codes are effective July, 1, 2021, but won’t be published until CPT® 2022:

90626   Tick-borne encephalitis virus vaccine, inactivated; 0.25 mL dosage, for intramuscular use

90627   Tick-borne encephalitis virus vaccine, inactivated; 0.5 mL dosage, for intramuscular use

90671   Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use

90677   Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use

90758   Zaire ebolavirus vaccine, live, for intramuscular use

These codes will be listed out of sequence. Medicare coverage will be determined by the Centers for Medicare & Medicaid Services in future rulemaking.

Update: CMS issued MLN Matters 12439 announces coverage for 90677, effective Oct. 1, 2021.

Update: Two more vaccine codes were accepted for the 2023 CPT® production cycle. These codes are effective on July 1, 2022.

90584 Dengue vaccine, quadrivalent, live 2 dose schedule, for subcutaneous use
This code is pending FDA approval.

90759 Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use

There is also one revised code (revisions are italicized), effective July 1:

90739 Hepatitis B vaccine (HepB), CpG-adjuvanted, adult dosage, 2 dose or 4 dose schedule, for intramuscular use

Source:

https://www.ama-assn.org/system/files/2021-01/vaccine-long-descriptors.pdf

https://www.ama-assn.org/practice-management/cpt/category-i-vaccine-codes

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Renee Dustman

Managing Editor at AAPC

Renee Dustman, BS, AAPC MACRA Proficient, is managing editor - content & editorial at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 30 years' experience in journalistic reporting, print production, graphic design, and content management. Follow her on Twitter @dustman_aapc.

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