Has the AMA announced new CPT codes for the recently approved bivalent COVID-19 boosters that are formulated to better address Omicron sub-variants?
Yes. On August 31, 2022, the AMA announced the creation of 8 new CPT codes to report for the reformulated Moderna and Pfizer bivalent COVID-19 vaccine boosters. Both manufacturers as well as the FDA, through separate press releases, cite the need for enhanced protection through fall and winter months against Omicron, which remains the predominant COVID-19 variant of concern in the US. Per the AMA, CPT codes 91313, 0134A, 91312 and 0124A are “effective for use immediately”. For your convenience, we have provided the long descriptor for each of the codes below.
Moderna bivalent booster codes (approved by the FDA for administration to patients 18 years and older):
91313 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use
0134A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, booster dose
Pfizer-BioNTech bivalent booster codes (approved by the FDA for administration to patients 12 years and older):
91312 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use
0124A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, booster dose
It is important to note, CMS has yet to officially recognize the 4 new codes noted above – however, this has not been uncommon throughout the COVID-19 Public Health Emergency (PHE). On average, we’ve seen about a one-week delay from the time the AMA announces new CPT codes, to the time CMS and MACs officially recognize the codes. Therefore, we fully expect these codes to be accepted by CMS and for the effective date to be recognized as August 31, 2022 – the same day the FDA amended the emergency use authorization (EUAs) for these products.
Through the same press release, 4 additional CPT codes were announced by the AMA; 91314, 0144A, 91315, 0154A, however these codes are NOT yet effective. These additional codes will be available for use upon the FDA approving an amendment to each vaccine’s EUA to allow use in the age ranges noted below. The Craneware Group will continue to provide updates on all COVID-19 related code changes if and when they occur.
Proposed codes for the Moderna bivalent pediatric booster (if approved, these codes will be applicable to administration in patients 6-11 years old):
91314 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use
0144A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRN-LNP, spike protein, bivalent, preservative free, 25 mcg/0.25 mL dosage, booster dose
Proposed codes for the Pfizer-BioNTech bivalent pediatric booster (if approved, these codes will be applicable to administration in patients 5-11 years old):
91315 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
0154A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, booster dose
Resources:
AMA press release, AMA Announces CPT update for COVID-19 boosters adapted to omicron:
FDA news release, Coronavirus (COVID-19) Update: FDA Authorizes Moderna, Pfizer-BioNTech Bivalent COVID-19 Vaccines for Use as a Booster Dose: