As most know by now, the FDA amended the emergency use authorizations (EUAs) for both the Pfizer BioNTech COVID-19 vaccine (PDF) and the Moderna COVID-19 vaccine (PDF) to allow for an additional dose in certain immunocompromised people.
Effective August 12, 2021, CMS will pay to administer additional doses of COVID-19 vaccines consistent with the FDA EUAs, using CPT code 0003A for the Pfizer vaccine and CPT code 0013A for the Moderna vaccine. Medicare and the various medicare administrators will pay the same amount to administer this additional dose as we did for other doses of the COVID-19 vaccine (approximately $40 each).
CMACs will hold and then process all claims with these codes after they complete claims system updates (most are no later than August 27th).
Complete List of Covid-19 Vaccine Codes
Below, we’ve provided a list of all CPT codes along with the reimbursement rates.
| CPT CODE | Short Description | Vaccine Name | Procedure Name | Payment Allowance on or after 3/15 | Payment Allowance through 3/14 | Effective Date |
|
91300 |
SARSCOV2 VAC 30MCG/0.3ML IM | Pfizer | Pfizer-Biontech Covid-19 Vaccine | $0.010[1] | $0.010[1] | 12/11/2020 – TBD |
| 0001A | ADM SARSCOV2 30MCG/0.3ML 1ST | Pfizer | Pfizer-Biontech Covid-19 Vaccine Administration – First Dose | $40.000[2] | $16.940[2] | 12/11/2020 – TBD |
| 0002A | ADM SARSCOV2 30MCG/0.3ML 2ND | Pfizer | Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose | $40.000[2] | $28.390[2] | 12/11/2020 – TBD |
| 0003A | ADM SARSCOV2 30MCG/0.3ML 3RD | Pfizer | Pfizer-Biontech Covid-19 Vaccine Administration – Third Dose | $40.000[2] | N/A | 08/12/2021 – TBD |
|
91301 |
SARSCOV2 VAC 100MCG/0.5ML IM | Moderna | Moderna Covid-19 Vaccine | $0.010[1] | $0.010[1] | 12/18/2020 – TBD |
| 0011A | ADM SARSCOV2 100MCG/0.5ML1ST | Moderna | Moderna Covid-19 Vaccine Administration – First Dose | $40.000[2] | $16.940[2] | 12/18/2020 – TBD |
|
0012A |
ADM SARSCOV2 100MCG/0.5ML2ND | Moderna | Moderna Covid-19 Vaccine Administration – Second Dose | $40.000[2] | $28.390[2] | 12/18/2020 – TBD |
|
0013A |
ADM SARSCOV2 100MCG/0.5ML3RD | Moderna | Moderna Covid-19 Vaccine Administration – Third Dose | $40.000[2] | N/A | 08/12/2021 – TBD |
|
91302 |
SARSCOV2 VAC 5X10^10VP/.5MLIM | AstraZeneca | AstraZeneca Covid-19 Vaccine | $0.010[1] | Code not active during this time | xx/xx/xxxx – TBD |
| 0021A | ADM SARSCOV2 5X10^10VP/.5ML 1 | AstraZeneca | AstraZeneca Covid-19 Vaccine Administration – First Dose | $40.000[2] | Code not active during this time | xx/xx/xxxx – TBD |
| 0022A | ADM SARSCOV2 5X10^10VP/.5ML 2 | AstraZeneca | AstraZeneca Covid-19 Vaccine Administration – Second Dose | $40.000[2] | Code not active during this time | xx/xx/xxxx – TBD |
| 91303 | SARSCOV2 VAC AD26 .5ML IM | Janssen | Janssen Covid-19 Vaccine[3]*** | $0.010[1] | $0.010[1] | 02/27/2021 – TBD |
| 0031A | ADM SARSCOV2 VAC AD26 .5ML | Janssen | Janssen Covid-19 Vaccine Administration[3]*** | $40.000[2] | $28.390[2] | 02/27/2021 – TBD |
| 91304 | SARSCOV2 VAC 5MCG/0.5ML IM | Novavax | Novavax Covid-19 Vaccine | $0.010[1] | Code not active during this time | xx/xx/xxxx – TBD |
| 0041A | ADM SARSCOV2 5MCG/0.5ML 1ST | Novavax | Novavax Covid-19 Vaccine Administration – First Dose | $40.000[2] | Code not active during this time | xx/xx/xxxx – TBD |
| 0042A | ADM SARSCOV2 5MCG/0.5ML 2ND | Novavax | Novavax Covid-19 Vaccine Administration – Second Dose | $40.000[2] | Code not active during this time | xx/xx/xxxx – TBD |
| M0201 | Covid-19 vaccine home admin | Home vaccine admin | Covid-19 vaccine administration inside a patient’s home; reported only once per individual home per date of service when only covid-19 vaccine administration is performed at the patient’s home | $35.50[2] | Code not active during this time | 06/08/2021 – TBD |