COVID-19 Billing Guide

Mar 22, 2021 | Billing

There are 11 new CPT codes for COVID-19 vaccines. Each vaccine has a specific vaccine administration code. The appropriate administration code is chosen based on the type of vaccine and which dose in the schedule (first or second dose) the patient receives.

CPT Code Vaccine Code Descriptor Vaccine Administration Code(s) Vaccine Name(s) NDC 10/NDC 11 Labeler Product
ID (Vial)
Dosing Interval Effective Date
91300 COVID-19 vaccine, mRNA- LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use 0001A (1st dose)
0002A (2nd dose)
Pfizer-
BioNTech
COVID-19
Vaccine
59267-1000-1
59267-1000-01
21 Days 12/11/2020
91301 COVID-19 vaccine, mRNA- LNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use 0011A (1st dose)
0012A (2nd dose)
Moderna
COVID-19
Vaccine
80777-273-10
80777-0273-10
28 Days 12/18/2020
91302 COVID-19 vaccine, DNA, spike protein, chimpanzee adenovirus
Oxford 1 (ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use
0021A (1st Dose)
0022A (2nd Dose)
AstraZeneca
COVID-19
Vaccine
0310-1222-10
00310-1222-10
28 Days TBD
92303 COVID-19 vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use 0031A (Single
dose)
Janssen
COVID-19
Vaccine
59676-580-05
59676-0580-05
Not
applicable
2/27/2021

Billing for the COVID-19 vaccine requires the use of 2 codes. The first code would be for the vaccine which identifies the manufacturer, and second code which identifies which dose is being administered.

If administering COVID-19 vaccines, received from the government and NOT the manufacturer, DO NOT code the CPT code for the vaccine. Code only the appropriate administration code according to the dose with ICD-10 code Z23.

Billing Example:

Pfizer COVID-19 Vaccine First Dose, vaccine received from Manufacturer:

  • Vaccine CPT: 91300
  • Administration: 0001A
  • ICD-10: Z23
  • NDC: 59267-1000-01

Billing Example:

Pfizer COVID-19 Vaccine Second Dose, vaccine received from government:

  • No Vaccine CPT code as received from government.
  • Administration: 0002A
  • ICD-10: Z23
  • NDC: 59267-1000-01

Since the Federal Government will be providing the COVID-19 vaccine when it first becomes available, there will be no reimbursement for the vaccine itself. However, there will be reimbursement for the administration of the vaccine.

For Vaccines given March 14, 2021 and Earlier

Moderna & Pfizer First Dose $16.94
Moderna & Pfizer Second Dose $23.39
Janssen (J&J) Single Dose $28.39
** These rates will be adjusted by geographic location**

For Vaccines given on or after March 15, 2021

Moderna & Pfizer First Dose $40.00
Moderna & Pfizer Second Dose $40.00
Janssen (J&J) Single Dose $40.00
** These rates will be adjusted by geographic location**

Detailed information about the COVID-19 CPT vaccine and immunization codes can be found on the AMA website: https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes.
To keep up to date with CMS and payment allowances updates for COVID-19 vaccines, go to: https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonalantibodies