Novavax COVID-19 Vaccine Receives EUA
- By Deborah Marsh
- In Coding
- July 20, 2022
- Comments Off on Novavax COVID-19 Vaccine Receives EUA
Here’s what you need to know to properly code this latest vaccination for SARS-CoV-2.
The Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the Novavax COVID-19 vaccine on July 13, 2022, for individuals 18 years and older. This EUA comes more than a year after the American Medical Association (AMA) released new codes for the Novavax vaccine on May 4, 2021.
The CPT® codes for the Novavax vaccine and administration are:
91304 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage, for intramuscular use
0041A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5 mL dosage; first dose
0042A second dose
Update: On Aug. 19, 2022, the FDA granted EUA of the Novavax COVID-19 vaccine for individuals 12 to 17 years of age, given in two doses, three weeks apart.
For dates of service after March 15, 2021, Medicare pays approximately $40 for each vaccine administration. Providers should not bill for the vaccine if it was supplied for free.
How to Apply the Codes
The codes for the Novavax vaccine follow the same structure that you’re used to from other COVID-19 vaccine codes. The code for the supply of the vaccine is 91304. You should report this code with the appropriate administration code based on whether it’s the patient’s first dose (0041A) or second dose (0042A).
Because the supply of the vaccine is typically free at this point, payers may have specific rules about coding and billing the product. Be sure to check the payer’s policy to avoid issues with your claims.
What Are Those Technical Terms?
The code descriptors refer to a “recombinant spike protein nanoparticle” vaccine. Recombinant means bringing together genetic material from multiple sources. The vaccine uses a protein encoded by the SARS-CoV-2 spike protein’s genetic sequence. The spike protein is what the coronavirus uses to bind to host cells. The tiny spike protein nanoparticles in the vaccine trigger an immune response that helps protect the patient from getting COVID-19.
The descriptors also refer to a “saponin-based adjuvant.” Saponins are compounds with a foaming characteristic. As an adjuvant, their goal is to improve the vaccine’s effectiveness by attracting immune cells and increasing their response.
Learn More Here
When the AMA first released these codes, the association posted the 2021 CPT® Assistant Special Edition: May Update to provide guidance on proper use of 91304, 0041A, and 0042A.
AMA’s CPT® appendix that lists COVID-19 vaccine information also includes these codes, linking them to the Novavax COVID-19 vaccine with National Drug Codes (NDCs) 80631-100-01 and 80631-1000-01.
You can find links to both of those resources on AMA’s page for COVID-19 CPT® vaccine and immunization codes.
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