A guide to coding COVID-19 bivalent vaccines for kids

Editor's note: the codes in this article are only active until Nov. 1, 2023. For updated codes, see this post.

Young children are now eligible for bivalent COVID-19 shots (geared to both the original strain of the virus and the omicron variant) even if they started their primary series with the monovalent shot.

Here’s how to code the bivalent shots for young patients from Pfizer (for ages six months to four years) and Moderna (for ages six months to five years).

Pfizer

If the patient has already received one dose of the monovalent vaccine, report 91317 (Pfizer, bivalent 0.2mL) with 0172A for the second dose in the series (including the monovalent dose as dose 1). If the patient has received two doses of the Pfizer monovalent vaccine, again report 91317, but add administration code 0173A to indicate it’s the third dose in the series (including the two monovalent doses).

Patients ages six months to four years who completed their entire primary series with the monovalent vaccine are also eligible to receive a bivalent booster as long as it’s been at least two months since they finished the primary series. Report these boosters with 91317 and administration code 0174A.

Here's a brief summary of how to code Pfizer shots for kids six months to four years who are switching from monovalent to bivalent:

For previously unvaccinated children who receive Pfizer's bivalent COVID-19 vaccine:

• Report administration of the three-dose series of bivalent vaccine in patients six months to four years with 91317 and administration codes 0171A- 0173A.
• Report administration of the single-dose bivalent vaccine to patients 5-11 years old with 91315 and 0151A.
• Report administration of the single-dose bivalent vaccine to patients ages 12 and older with 91312 and 0121A.

Moderna

Moderna’s bivalent vaccine regimen for young patients is slightly more complicated because it calls for different doses depending on how many monovalent shots the patient has had.

Patients six months to five years old who previously received two doses of the monovalent COVID-19 vaccine receive one 0.2 ml dose of the Moderna bivalent vaccine. Report this with 91316 (Moderna, 02.ml dose) and administration code 0164A (additional dose).

Patients in that age group who have received only one dose of the monovalent vaccine should get a 0.25 ml Moderna bivalent vaccine (no further doses are necessary for the primary series). Report this with 91314 (Moderna, 0.25 ml, bivalent vaccine) and administration code 0142A (second dose).

Here's a brief summary of how to code Moderna shots for kids six months to four years who are switching from monovalent to bivalent:

Previously unvaccinated patients aged six months to five years should receive a two-dose series of the 0.25 ml vaccine reported with 91314 and administration codes 0141A and 0142A.

The same 0.25 ml bivalent dose is used for patients age 6-11 who previously received one or more monovalent doses. Report this with 91314 (Moderna, 0.25 ml, bivalent vaccine) and administration code 0144A (additional dose). Administration of the bivalent vaccine to previously unvaccinated patients in this age group is reported with 91314 and 0141A.

Patients 12 and up receive a 0.5 ml bivalent vaccine dose, whether they previously received a monovalent shot or not. Report this using 91313 (Moderna, 0.5 ml, bivalent vaccine) with administration code 0134A (additional dose).

See the full interim prescribing schedule (https://www.cdc.gov/vaccines/covid-19/downloads/COVID-19-immunization-schedule-ages-6months-older.pdf) for guidance on completing immunization when vaccines from other manufacturers were previously administered or previous dose is unknown.

— Cindy Hughes, CPC, CFPC

Posted on May 24, 2023