CPT CODE AND Description

91311 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use

Administration codes

0111A 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, 25 mcg/0.25 mL dosage; first dose

0112A 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, 25 mcg/0.25 mL dosage; second dose

Billing Guidelines

The provisional CPT codes are effective for use on the condition that Moderna’s pediatric COVID-19 vaccine 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.

“Authorization of a vaccine for children age 5 and younger would be another important milestone in the fight against COVID-19,” said AMA President Gerald Harmon, M.D. “Extending COVID-19 vaccination protection to approximately 18 million young children will significantly reduce their risk of COVID-19 infection, hospitalization, and death, and give their parents incredible peace of mind. We strongly urge all parents to get their infants and toddlers vaccinated as soon as they are eligible for a COVID-19 vaccine.”

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, 38 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.

* (Report 91311with administration codes0111A, 0112A)
* (Do not report 91311 in conjunction with administration codes 0011A, 0012A, 0013A, 0064A, 0094A)

Code 91311 describes Moderna’s new vaccine product for pediatric patients aged 6 months through 5 years. This vaccine uses a 25 mcg/0.25 mL dosage concentration. Vaccine administration code 0111A should be reported for the administration of the first dose of the primary series and with code 0112A for the second dose of the primary series.

As with previous COVID-19 vaccine administration codes, counseling is included as part of the administration visit and should not be reported separately. The physician or other qualified health care professional (QHP) should exercise clinical judgment to determine whether the administration of the vaccine product is appropriate for a given patient. More information on current guidance from the Centers for Disease Controland Preventionregarding whichpatients should receive a COVID-19 vaccine booster dose is available athttps://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines.html.

Note that vaccine administration codes0111A and 0112A are only intended to be reported with vaccine product code 91311.Parenthetical notes have been added following the administration and product codesto clarify the appropriate use of these new codes.

Clinical Example (91311)

A parent or guardian of a 1-year-old child seeks immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence supported guidelines. The parent orguardian is offered and agrees to an intramuscular injection of SARS-CoV-2 vaccine for the child for this purpose.

Description of Procedure (91311)

The physician or other qualified healthcare professional (QHP) determines that the SARS-CoV-2 vaccine is appropriate for this patient and dispenses the vaccine according to the dose scheduled in the administration code for the SARS-CoV-2 vaccine.

Clinical Example (011AA)

A parent or guardian of a 1-year-old child seeks immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence-supported guidelines. The parent or guardian is offered and agrees to an intramuscular injection of SARS-CoV-2 vaccine for the child for this purpose

Description of Procedure (0111A)

The physician or other QHP reviews the patient’s chart to confirm that vaccination to decrease the risk of COVID-19 is indicated. Counsel the parent or guardian on the benefits and risks of vaccination to decrease the risk of COVID-19 and obtain consent. Administer the first dose of CPT ® Assistant Special Edition: May Update / Volume 32 • 20224the COVID-19 vaccine by intramuscular injection. Monitor the patient for any adverse reaction. Update the patient’s immunization record (and registry when applicable) to reflect the vaccine administered.

Clinical Example (0112A)

A parent or guardian of a 1-year-old child seeks immunization against SARS-CoV-2 to decrease the risk of contracting this disease, consistent with evidence-supported guidelines. The parent or guardian is offered and agrees to an intramuscular injection of SARS-CoV-2 vaccine for the child for this purpose

Description of Procedure (0112A)

The physician or other QHP reviews the patient’s chart to confirm that vaccination to decrease the risk of COVID-19 is indicated. Counsel the parent or guardian on the benefits and risks of vaccination to decrease the risk of COVID-19 and obtain consent. Administer the second dose of the COVID-19 vaccine by intramuscular injection. Monitor the patient for any adverse reaction. Update the patient’s immunization record (and registry when applicable) to reflect the vaccine administered.