The American Medical Association (AMA) (@AmerMedicalAssn) announced an editorial update to Current Procedural Terminology (CPT®), the nation’s leading medical terminology code set for describing health care procedures and services, that includes newly assigned provisional CPT codes for COVID-19 booster candidates from Pfizer and Sanofi-GlaxoSmithKline.
The Pfizer booster candidate is proposed for use in children ages 5 to 11 who have completed a COVID-19 vaccine primary series, while the Sanofi-GSK booster candidate is proposed for use in persons age 18 and older who have completed a COVID-19 vaccine primary series.
Each provisional CPT codes is effective for use on the condition that its assigned booster candidate is granted an Emergency Use Authorization by the U.S. Food and Drug Administration (FDA). The AMA is publishing the CPT code update now to ensure electronic systems across the U.S. health care system are prepared in advance for the potential FDA authorization.
“As the highly contagious Omicron BA.2 coronavirus subvariant is causing an increase in COVID-19 infections across the country, the American Medical Association continues to strongly urge every eligible individual to make sure they are up to date on their COVID-19 vaccinations, including booster doses,” said AMA President Gerald E. Harmon, M.D. “To provide further protection, people age 50 and older, as well as immunocompromised individuals age 12 and older, may also consider getting a second booster dose at least 4 months after an initial booster dose. We urge patients to check the CDC’s guidance on COVID-19 boosters and review the available options with a physician.”
CPT codes clinically distinguish each coronavirus vaccine and dosing schedule to allow for data-driven tracking, reporting and analysis that supports planning and allocation during the public health response to the pandemic. To date, 35 CPT codes have been created for reporting COVID-19 vaccines.
To help ensure accurate coding and reporting of COVID-19 vaccines and immunization services, the AMA offers a vaccine code finder resource to help identify the appropriate CPT code combination for the type and dose of COVID-19 vaccine provided to each patient.
For quick reference, the new product code and administration codes assigned to each COVOVID-19 booster candidate are:
Product and administration codes for Sanofi-GSK booster candidate
- 91310 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, for intramuscular use
- 0104A – Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, monovalent, preservative free, 5 mcg/0.5 mL dosage, adjuvant AS03 emulsion, booster dose
Administration code for Pfizer booster candidate
- 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
Short, medium and long descriptors for all the new vaccine-specific CPT codes can be accessed on the AMA website, along with other recent modifications to the CPT code set that have helped streamline the public health response to the SARS-CoV-2 virus and the COVID-19 disease.
Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel that collects broad input from the health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care system. This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology so it can fulfill its vital role as the trusted language of medicine today and the code to its future.
Questions on CPT coding and content should be directed to the CPT Network, the authoritative source for CPT coding answers. Also consult the AMA online library of COVID-19 CPT coding and guidance.
About the American Medical Association
The American Medical Association is the physicians’ powerful ally in patient care. As the only medical association that convenes 190+ state and specialty medical societies and other critical stakeholders, the AMA represents physicians with a unified voice to all key players in health care. The AMA leverages its strength by removing the obstacles that interfere with patient care, leading the charge to prevent chronic disease and confront public health crises and, driving the future of medicine to tackle the biggest challenges in health care.