Changes to COVID-19 Vaccines Strike Again

December 12th, 2023 - Aimee Wilcox

Just as medical coders are receiving the new 2024 CPT codebook, changes to it have already occurred. The COVID-19 vaccine products and administration codes have, yet again, been changed and drastically so. So why the sudden change? Well, according to the Centers for Disease Control and Prevention (CDC),

Since September 2022, bivalent mRNA COVID-19 vaccines have been recommended in the United States, but the variants these vaccines were designed to protect against are no longer circulating widely.”

And, according to the US Food and Drug Administration (FDA),

U.S. Food and Drug Administration took action approving and authorizing for emergency use updated COVID-19 vaccines formulated to more closely target currently circulating variants and to provide better protection against serious consequences of COVID-19, including hospitalization and death.”

The FDA then approved an emergency use authorization for the monovalent COVID-19 vaccines on September 11, 2023. As a result, all of the previously authorized COVID-19 vaccines and boosters, except for the Novavax COVID-19 vaccine (see CPT code 91304) are no longer authorized, and as such are no longer billable with the codes as seen in Appendix Q of the CPT codebook.

In preparation for the coming change, on August 14th, the American Medical Association (AMA) released a CPT Assistant an Erratum for Special Edition: August Update outlining this change and identifying correct coding guidelines and codes for reporting these new COVID-19 vaccines. However, if you have already received your 2024 CPT codebook, you will not find these new codes and guidelines in it. Additionally, the AMA announced that in its 2025 CPT codebook, Appendix Q will be deleted, as all guidance within that appendix is no longer valid with these COVID-19 vaccine changes.

Therefore, just as we did during the public health emergency (PHE) coders will be required to access a separate website to access immunization feature updates from the CPT Editorial Panel regarding these products, as they are approved.

Due to the evolving nature of immune globulins, vaccines, and toxoids, the AMA has decided to publish in the CPT codebook, when available, the new immune globulin product codes, prior to approval by the FDA and identify these with a lightning bolt symbol in front of the code. The website noted above, will remove the symbol once the immune globulin product has become FDA-approved and the published codebook will reflect those same changes the following year. As a coder and auditor, this begs the question as to whether the AMA will simply stop printing codebooks and move to a fully digital codebook, especially if the codes have changed even before the coder gets a hold of the newest edition.

In summary, as of November 1, 2023

All COVID-19 administration codes ending in an A have been deleted (not reflected in the CPT 2024 codebook), and replaced with a single COVID-19 vaccine administration code (90480).
All COVID-19 vaccine products have been deleted with the exception of the Novavax COVID-19 vaccine product (see CPT 91304) and replaced with the new monovalent vaccine products for COVID-19:
- Pfizer monovalent COVID-19 vaccines reportable with CPT codes: 91318, 91319, 91320 and administration code 90480
- Moderna monovalent COVID-19 vaccines reportable with CPT codes: 91321 and 91322 and administration code 90480
- Novavax COVID-19 vaccine, reportable with CPT code: 91304 and administration code 90480
- Appendix Q is no longer a viable appendix and should not be referred to after November 1, 2023

The AMA has established a website to help coders differentiate and report the correct vaccine product codes and associated vaccine administration codes. With so many changes occurring it is important to document and track all resources that may not be readily available in your codebooks or encoder tools and be sure to verify your encoder vendor will update the product to reflect these changes.

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