Is there a new CPT code that should be reported for the recently authorized Pfizer COVID-19 vaccine booster dose for children?
Yes. On May 17, 2022, the FDA amended the emergency use authorization 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 when the booster is administered at least five months after completion of a primary series. For your convenience, we have provided the long description for the new booster-specific administration code below.
- 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
CPT code 0074A represents the administration portion of the service. The vaccine product itself will continue to be reported with CPT 91307, which was previously approved on October 29, 2021. For your convenience, the long descriptor for the vaccine product is provided below.
- 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
We remind providers that per CMS directive, if you receive a COVID-19 vaccine product free of charge, you should only bill for the administration services and not the drug products themselves. For providers whose systems require a product code to bill for the administration, a token charge of $0.01 may be reported for the drug product.
Resources:
FDA News Release, “Coronavirus (COVID-19) Update: FDA Expands Eligibility for Pfizer-BioNTech COVID-19 Vaccine Booster Dose to Children 5 through 11 Years”
https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-expands-eligibility-pfizer-biontech-covid-19-vaccine-booster-dose
CPT Assistant, Special Edition April 2022
https://www.ama-assn.org/system/files/cpt-assistant-guide-coronavirus-april-2022.pdf
CMS COVID-19 Vaccines website
https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies