Use 0074A for COVID-19 Pediatric Booster
- By Deborah Marsh
- In Coding
- May 18, 2022
- 2 Comments
Limit this code to administration of the Pfizer-BioNTech vaccine.
On May 17, 2022, the U.S. Food and Drug Administration (FDA) amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 vaccine to authorize the use of a booster dose for patients 5 through 11 years of age.
The CPT® code to report administration of this booster is 0074A 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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose. The American Medical Association (AMA) published this new code on its COVID-19 CPT vaccine and immunization codes site on April 26, 2022, noting that the code would be effective upon receiving EUA or approval from the FDA.
Pair 0074A With 91307
The COVID-19 vaccine supply code that applies to admin code 0074A is existing CPT® code 91307 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use.
Code 91307 is the same supply code that you use when reporting the first through third doses of the vaccine using 0071A to 0073A.
Keep Reporting Rules Straight
When your practice follows the various rules for reporting, you can expect payment for administration of COVID-19 vaccines from payers. But remember that the Centers for Medicare & Medicaid Services (CMS) anticipates that providers typically will not currently incur a cost for the supply of COVID-19 vaccine products and states, “Providers should not bill for the product if they received it for free.” Reporting and billing rules may vary for these codes, so be sure to check the payer’s policy.
Also remember that COVID-19 vaccine administration codes include counseling as part of the administration visit, so you should not report a separate code for counseling, according to the April special edition of CPT® Assistant.
Note: The American Medical Association has made several revisions to COVID-19 vaccine and administration coding since this article was published. Please make sure coding is appropriate for date of service.
- Use Codify Indexes? Don’t Miss This Timesaving Tip - September 1, 2023
- Get Ready to Relearn COVID-19 Vaccine Coding - August 23, 2023
- Use Notepad in Codify to Create a Code List - August 1, 2023
Can you use 0074A for the 1st booster?
Dee, the FDA announcement refers to authorizing the use of a single booster: “The U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine, authorizing the use of a single booster dose for administration to individuals 5 through 11 years of age at least five months after completion of a primary series with the Pfizer-BioNTech COVID-19 Vaccine.” CMS indicates 0074A is appropriate for “Pfizer-BioNTech Covid-19 Pediatric Vaccine (Orange Cap) – Administration – Booster.” A footnote attached to the code states, “Administration booster codes should be billed for all applicable booster doses as approved and/or authorized by the FDA” (Medicare Part B Payment). Based on that information, 0074A is appropriate for the first booster.