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Are the CPT codes for the Pfizer-BioNTech COVID-19 vaccine now active?

Yes. On December 14, 2020, CMS published a MLN Connects Special Edition bulletin re-affirming that Medicare will cover the Pfizer-BioNTech COVID-19 vaccine when furnished in accordance with the FDA’s Emergency Use Authorization. CMS has also updated its COVID-19 Vaccines and Monoclonal Antibodies website to indicate that the applicable Pfizer-BioNTech vaccine CPT codes are retroactively effective back to 12/11/2020, the date the vaccine was granted its EUA by the FDA.

It is important to highlight that both the Special Edition bulletin and the CMS COVID-19 Vaccine website instruct providers not to bill for the vaccine product itself, CPT 91300, if the provider receives the vaccine at no cost. In these instances, providers would report the appropriate administration code only; CPT 0001A for the first dose and CPT 0002A for the second dose.

 
Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name Payment Allowance Effective Dates
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer Pfizer-Biontech Covid-19 Vaccine $0.010* 12/11/2020 – TBD
0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – First Dose $16.940** 12/11/2020 – TBD
0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose $28.390** 12/11/2020 – TBD
 

As always, we would caution there may be a delay for both MACs and commercial payers to update their respective claims processing systems to accept these new codes. We would advise confirming code availability with your respective payers prior to claim submission.

CMS MLN Connects Special Edition, “COVID-19 Vaccine Codes: Updated Effective Date for Pfizer-BioNTech”:
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-12-14-mlnc-se

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