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:
The following populations may receive the booster shot:
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
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