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