COVID-19 booster shots: who’s eligible, and how to code them
Editor's note: the codes in this article are only active until Nov. 1, 2023. For updated codes, see this post.
The Centers for Disease Control and Prevention (CDC) is recommending a booster shot of the Pfizer-BioNTech COVID-19 vaccine for certain patients. The agency recommends a booster for individuals 65 and older and long-term care residents, as well as adults younger than 65 who are at high risk for severe COVID-19 due to underlying medical conditions or at high risk for COVID-19 exposure due to their institutional or occupational settings.
The booster should be administered at least six months after a person’s primary series of the Pfizer-BioNTech COVID-19 vaccine. The agency will review booster shot data for the Moderna and Johnson & Johnson vaccines once it’s available.
At this time, the CDC is NOT recommending COVID-19 booster shots for the general public. Its specific recommendations are:
The following populations should receive the Pfizer COVID-19 booster shot:
- People 65 years and older and residents of long-term care settings and
- People aged 50-64 years with underlying medical conditions.
The following populations may receive the booster shot:
- People aged 18-49 with underlying medical conditions, based on their individual benefits and risks, and
- People aged 18-64 who are at increased risk for COVID-19 exposure and transmission because of occupational or institutional setting, based on their individual benefits and risk.
The American Medical Association (AMA) has updated its coding guidance to include a CPT administration code for the Pfizer booster. (The AMA’s COVID-19 vaccine coding tool is available here, and the FPM Getting Paid COVID-19 vaccines coding guide is available here.)
| Pfizer-BioNTech vaccine CPT code | Administration codes |
|---|---|
| 91300 - Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use | • 0001A (1st dose) • 0002A (2nd dose) • 0003A (3rd dose) • 0004A (booster) |
Note that the CPT administration code for the booster is different than for the third dose. As a reminder, the third dose is recommended for individuals with moderately to severely compromised immune systems that may not have built the same level of immunity with a two-dose series compared to those who are not immunocompromised.
Medicare and most commercial payers will cover the COVID-19 vaccine and administration, including boosters, without any cost-sharing for eligible individuals.
— Erin Solis, Manager, Practice & Payment at the American Academy of Family Physicians
Posted on Sep 30, 2021 by Erin Solis