Have there been recent coding changes related to Pfizer COVID-19 vaccines?

Yes. On January 3, 2022, the FDA updated the emergency use authorization for the Pfizer pediatric COVID-19 vaccine (orange cap) to allow for third doses for certain immunocompromised children ages 5 through 11. It is important to highlight these are not booster doses – rather a third dosage of the vaccine for patients who meet certain clinical criteria. Additional information as to which pediatric patients qualify for a third dose can be found in the products emergency use authorization linked below. Administration of third doses will be reported with new CPT code 0073A, which CMS has confirmed will be retroactively effective back to January 3, 2022. The vaccine product itself will continue to be reported with CPT 91307. We have provided the long descriptions for both codes below for your convenience.

  • 0073A: Immunization administration by intramuscular injection of 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;third dose
  • 91307: 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, for intramuscular use

In addition to the update noted above, on January 3, 2022, the FDA also approved a new pre-diluted formulation of the Pfizer COVID-19 vaccine for patients 12 years and older. This product (which is packaged with a grey cap) and its associated administration services will be reported with the CPT codes noted below. CMS has confirmed that these codes will also be retroactively effective back to January 3, 2022.

  • 91305: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, trissucrose formulation, for intramuscular use
  • 0051A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation;first dose
  • 0052A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation;second dose
  • 0053A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation;third dose
    0054A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation;booster dose

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:

Pfizer-BioNTech COVID-19 Vaccine Emergency Use Authorization
https://www.fda.gov/media/150386/download

CMS COVID-19 Vaccines and Monoclonal Antibodies Homepage
https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

AMA press release, “AMA announces CPT update for third dose of Pfizer’s pediatric COVID-19 vaccine”
https://www.ama-assn.org/press-center/press-releases/ama-announces-cpt-update-third-dose-pfizer-s-pediatric-covid-19-vaccine

CDC, “Pfizer-BioNTech COVID-19 Vaccine (Gray Cap) Age 12 and Over”
https://www.cdc.gov/vaccines/covid-19/info-by-product/pfizer/bioNTech-gray-cap-12-and-over.html