How to code third doses of COVID-19 vaccines

Last week, the Centers for Disease Control and Prevention recommended that moderately to severely immunocompromised individuals receive a third dose of the Pfizer or Moderna COVID-19 vaccine.  

Effective Aug. 12, 2021, the Centers for Medicare & Medicaid Services (CMS) will cover the administration of the additional dose at the same rate as the others – approximately $40. CMS is updating its systems and will hold claims until the updates are complete. The agency has indicated it will process the held claims by Aug. 27.

The American Medical Association (AMA) released two new administration CPT codes for the additional doses:

These codes are only to be used for third doses for immunocompromised individuals, which are different than booster shots. While the Biden Administration has announced its intent to offer booster shots to the general population, there is not currently a formal recommendation or Food and Drug Administration approval for them. The AMA will update its coding guidance if a booster schedule is approved.

For a full guide to coding all of the COVID-19 vaccines, click here.

— Erin Solis, Manager of Practice and Payment, American Academy of Family Physicians