Coding for COVID-19 Immunizations
February 25, 2021
ACOG representatives to the American Medical Association (AMA) Current Procedural Terminology (CPT) Editorial Panel are working with vaccine developers and other physician societies to create vaccine and immunization administration codes for the COVID-19 vaccine as they submit Emergency Use Authorization (EUA) applications to the Federal Food and Drug Administration (FDA).
The AMA CPT Editorial Panel has approved the following codes:
Pfizer-BioNTech COVID-19 Vaccine (NCD 10/NCD 11: 59267-1000-1; 59267-1000-01) CPT 91300
- 1st Dose: 0001A
- 2nd Dose: 0002A
Moderna COVID-19 Vaccine (NCD 10/NCD 11: 80777-273-10; 80777-0273-10) CPT 91301
- 1st Dose: 0011A
- 2nd Dose: 0012A
AstraZeneca COVID-19 Vaccine (NCD 10/NCD 11: 0310-1222-10; 00310-1222-10) CPT 91302
- 1st Dose: 0021A
- 2nd Dose: 0022A
Janssen COVID-19 Vaccine (NCD 10/NCD 11: 59676-580-05; 59676-0580-05) CPT 91303
- 1st Dose: 0031A Single dose
As more vaccines and codes are approved, this table will be updated.
Insurance coverage of COVID-19 Vaccines
The federal government is supplying the vaccines for distribution to facilities and practices that are enrolled as Medicare providers or COVID-19 immunization administrators. Enrollment allows the facility or practice to bill for the administration of the vaccine using the Vaccine Administration codes above. Reimbursement is geographically adjusted and based on the national payment rate of $16.94 for the first dose and $28.39 for the second dose or single-dose.
The Centers for Medicare & Medicaid Services (CMS) is offering a provisional enrollment for facilities and providers who are not currently enrolled but would like to become a COVID-19 immunization administrator. An abbreviated enrollment process includes a quick call to the regional Medicare Administrative Contractor.
Please have available the following:
- Legal Business Name (LBN)
- National Provider Identifier (NPI)
- Tax Identification Number (TIN)
- Practice location
- State license (if applicable)
All Medicare patients are covered through the fee-for-service program, even if they are enrolled in a private Medicare plan. For all other payers, please reach out to the insurer for their billing and coverage policies.
- Submit a ticket to get your Coding questions answered
- ICD-10-CM Official Coding and Reporting Guidelines (PDF)
- AMA Quick reference flow chart for CPT reporting for COVID-19 testing (PDF)
- AMA Telehealth/COVID-19 coding scenarios (PDF)
- AMA Fact Sheet: Reporting Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2) Laboratory Testing
- SARS-CoV-2 Serologic Laboratory Testing
- Managing Patients Remotely: Billing for Digital and Telehealth Services
Private payers continue to update their policies as the COVID-19 public health crisis. To check each payer’s most updated policy changes in relation to the billing and coding for telehealth and COVID-19, please visit the payer’s website.