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What are the changes to billing for administration of Moderna’s COVID-19 vaccine to pediatric patients?

On July 6, 2022, the AMA announced the creation of three new administration codes; 0091A, 0092A and 0093A to report for Moderna COVID-19 vaccine administration in pediatric patients aged 6-11 years. These codes are to be reported with previously established Moderna vaccine product code 91309. Per the AMA, these codes are retroactively effective back to June 17, 2022, the date the FDA amended the Emergency Use Authorization for the Moderna vaccine to expand the age range for eligible pediatric patients.

For your convenience, we have provided the long descriptors for the new codes below.

0091A: 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, 50 mcg/0.5 mL dosage; first dose when administered to individuals 6 through 11 years

0092A: 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, 50 mcg/0.5 mL dosage; second dose when administered to individuals 6 through 11 years

0093A: 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, 50 mcg/0.5 mL dosage; third dose when administered to individuals 6 through 11 years

Although there was no change to the code descriptors, the applicable age for the adult Moderna vaccine product (CPT 91301) and its associated administration codes (CPTs 0011A, 0012A and 0013A) has been revised from 18 years and older to 12 years and older. The AMA did revise the long descriptor for booster administration CPT 0094A to clarify the eligible age as 18 years or older.

0094A: 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, 50 mcg/0.5 mL dosage; booster dose when administered to individuals 18 years and over

The Panel also approved an additional 3rd dose vaccine administration code, CPT 0113A, that is to be reported with the previously established Moderna vaccine product code, CPT 91311, for pediatric patients aged 6 months through 5 years.

0113A: Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus (SARS-Co-V-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage; third dose

We remind providers that per CMS directive, if you receive a COVID-19 vaccine product free of charge, you should only bill for the administration services and not the drug products themselves. For providers whose systems require a product code to bill for the administration, a token charge of $0.01 may be reported for the drug product. There may also be a delay in payers incorporating these new codes into their claims processing systems. We would advise confirming code availability with your respective payers prior to claim submission.

AMA CPT Assistant, Special Edition: July 2022 Update:
https://www.ama-assn.org/system/files/cpt-assistant-guide-coronavirus-july-2022.pdf

AMA COVID-19 CPT Vaccine and Immunization Codes
https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-vaccine-and-immunization-codes

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