In a recent development_the American Medical Association (AMA) has issued new Current Procedural Terminology (CPT) codes_to report the Pfizer vaccine and administration for pediatric doses of the COVID-19. Earlier Pfizer and BioNTech conducted clinical trials to check the effectiveness of the Covid-19 vaccine in children. However, in September 2021, both companies submitted the results to the Food and Drug Administration (FDA).
According to which two doses of the vaccine bring about a strong immune response in children ages 5 to 11. Moreover, according to the officials of Pfizer. The company has put out a formal request to get approval for the emergency use and authorization of their COVID-19 vaccine in children ages 5 to 11. It’s worth mentioning here that: in August 2021, the Pfizer-BioNTech vaccine for individuals 16 and older got approval from the FDA.
The CPT codes for the pediatric Pfizer COVID-19 vaccine include;
91307: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative-free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use
0071A: 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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; first dose
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, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; second dose
AMA president, Gerald Harmon, in an official statement has said that: the AMA is committed to supporting the expansion of the COVID-19 immunization protection to a broader age range of children. He further elaborated that the Federal Drug Administration and Centers for Disease Control and Prevention will grant approval after a transparent review process of examining the safety and effectiveness_ of Pfizer’s COVID-19 vaccine for potential use in children between ages 5 and 11.
Earlier, in November 2020, the AMA first added COVID-19 vaccine codes to the CPT code set to report immunizations. The Association has since issued CPT codes for Pfizer, Moderna, AstraZeneca, Johnson & Johnson, and Novavax. The federal agencies have unveiled the medical codes for providing third doses or booster shots of the following vaccines.
|0013A||ADM SARSCOV2 100MCG/0.5ML3RD_ Vaccine Administration – Third Dose|
|91306||SARSCOV2 VAC 50MCG/0.25ML IM_Moderna Covid-19 Vaccine (Low Dose)|
|0064A||ADM SARSCOV2 50MCG/0.25MLBST_Moderna Covid-19 Vaccine (Low Dose) Administration – Booster|
|0053A||ADM SARSCOV2 50MCG/0.25MLBST_Moderna Covid-19 Vaccine (Low Dose) Administration – Booster|
In addition to this, CMS has also unveiled the insurance coverage for the booster shots for the vaccination against the covid-19, without cost-sharing. The Medicare payment rates for administering the vaccines after September 22, 2021, are:
- Approximately $40 for single-dose vaccines.
- For vaccines requiring multiple doses, approximately $40 for each dose in the series, including any additional doses and booster doses.
- For COVID-19 vaccines administered before March 15, 2021, the Medicare payment rates are:
- For vaccines requiring a series of 2 or more doses:
- $16.94 for the initial dose(s) in the series
- $28.39 for the final dose in the series
The primary goal of the earlier publication of these codes is to help practices across the United States. So they can prepare and update their medical billing systems and Electronic Health Records (EHRs) in advance. Which will help medical professionals to report the pediatric vaccine and its administration. In addition to updating the EHRs, providers should make sure that their billing and coding staff always stay at the top of the changes. It is crucial to assign the right medical codes for vaccinating pediatrics. Using precise medical codes is also important from a financial point of view. Because accurate coding is the essence of clean medical claims. Which are the keys to secure reimbursements from payers for providing the vaccine services.
Providers must keep in mind that the US federal authorities have allocated several funds to ensure the reimbursements for the providers. Particularly those who continue to vaccinate the consumers against the viral pandemic, even on the thin operating margins. Hence, in order to keep pace with the ever-changing medical codes for the covid-19 vaccine, providers should keep a close eye on all updates.
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