At last, the US is starting to vaccinate against COVID-19. For practices that are, or plan on administering the vaccinations, there are specific codes that will need to be used to receive reimbursement. Equally important is that there are a different administration codes for each manufacturer as well as for the first and second doses. Let’s take a look at how coding and reimbursement will work for coronavirus vaccines.

AMA Issues New CPT Codes for COVID-19 Vaccinations

In November the AMA approved and published two new CPT vaccine codes and their associated administration codes for the Pfizer and Moderna vaccines. These codes became effective when the FDA granted emergency use authorization.

The AMA assigned Category I code 91300 to the Pfizer vaccine and code 91301 to Moderna. To document the administration of the vaccines, AMA has also created codes 0001A, 0002A, 0011A, and 0012A. Code 0001A and 0011A describes the administration of the first dose of the Pfizer and Moderna vaccine respectively, while 0002A and 0012A describes the second dose of the vaccine.

Vaccine Code Vaccine Code Descriptor Vaccine Administration Code(s) Vaccine Manufacturer Vaccine Name(s) NDC10/NDC11 Labeler Product ID (Vial) Dosing Interval
91300 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use 0001A
(1st dose)0002A
(2nd dose)
Pfizer, Inc Pfizer-BioNTech COVID-19 Vaccine 59267-1000-1 59267-1000-01 21 days
91301 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, preservative free, 100 mcg/0.5mL dosage, for intramuscular use 0011A
(1st dose)0012A
(2nd dose)
Moderna, Inc Moderna COVID-19 Vaccine 80777-273-10 80777-0273-10 28 days

In December, the AMA also released a new code and associated codes for the AstraZenenca vaccine for COVID-19. These codes are subject to FDA approval or an emergency use authorization.

Vaccine Code Vaccine Code Descriptor Vaccine Administration Code(s) Vaccine Manufacturer Vaccine Name(s) NDC10/NDC11 Labeler Product ID (Vial) Dosing Interval
91302 Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, chimpanzee adenovirus Oxford 1(ChAdOx1) vector, preservative free, 5×1010 viral particles/0.5mL dosage, for intramuscular use 0021A
(1st Dose)0022A
(2nd Dose)
AstraZeneca, Plc AstraZeneca COVID-19 Vaccine 0310-1222-10
00310-1222-10
28 days

Payment Allowances and Effective Dates for COVID-19 Vaccines and Administration

CMS has stated that it will reimburse providers for COVID19 vaccines and their administration costs, but some restrictions apply.

  • CMS will reimburse only for those vaccines that are approved by the FDA or have emergency use authorization.
  • CMS will reimburse under Medicare Part B instead of Part D to provide the broadest coverage.
  • Medicare will provide 95% of the wholesale price of the vaccine. However, providers cannot bill for vaccines they have received for free.
  • Since CMS anticipates that providers, initially, will not incur a cost for the product they have set the payment allowances at $0.10 for the vaccines and will update the payment allowance at a later date when practices incur costs.
  • Administration of the vaccines are set at $16.94 for the first does and $28.39 for the second. These rates will be geographically adjusted as outlined in the Medicare Physician Fees Schedule.
Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name Payment Allowance Effective Dates
91300 SARSCOV2 VAC 30MCG/0.3ML IM Pfizer Pfizer-Biontech Covid-19 Vaccine $0.010 12/11/2020 – TBD
0001A ADM SARSCOV2 30MCG/0.3ML 1ST Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – First Dose $16.940 12/11/2020 – TBD
0002A ADM SARSCOV2 30MCG/0.3ML 2ND Pfizer Pfizer-Biontech Covid-19 Vaccine Administration – Second Dose $28.390 12/11/2020 – TBD
91301 SARSCOV2 VAC 100MCG/0.5ML IM Moderna Moderna Covid-19 Vaccine $0.010 12/18/2020 – TBD
0011A ADM SARSCOV2 100MCG/0.5ML1ST Moderna Moderna Covid-19 Vaccine Administration – First Dose $16.940 12/18/2020 – TBD
0012A ADM SARSCOV2 100MCG/0.5ML2ND Moderna Moderna Covid-19 Vaccine Administration – Second Dose  $28.390 12/18/202 – TBD
91302 SARSCOV2 VAC 5X10^10VP/.5MLIM AstraZeneca AstraZeneca Covid-19 Vaccine $0.010 TBD
0021A ADM SARSCOV2 5X10^10VP/.5ML 1 AstraZeneca AstraZeneca Covid-19 Vaccine Administration – First Dose $16.940 TBD
0022A ADM SARSCOV2 5X10^10VP/.5ML 2 AstraZeneca AstraZeneca Covid-19 Vaccine Administration – Second Dose  $28.390 TBD

Payment Allowances and Effective Dates for COVID-19 Monoclonal Antibodies and Administration

CMS also stated that it will reimburse providers for COVID-19 monoclonal antibodies and their administration costs, but similar to the vaccine, some restrictions apply.

  • CMS will reimburse only for those COVID antibodies that are approved by the FDA or have emergency use authorization.
  • Medicare will provide 95% of the wholesale price. However, providers cannot bill for antibodies they have received for free.
  • Payment allowances have initially been set at $0.10 for the injections and will be updated at a later date when practices begin to incur costs.
  • Medicare will pay a rate of $309.60 for many providers. This payment rate is based on one hour of infusion and post-administration monitoring in the hospital outpatient setting.
  • These rates will also be geographically adjusted for many providers according to the Medicare Physician Fee Schedule.
Code CPT Short Descriptor Labeler Name Vaccine/Procedure Name Payment Allowance Effective Dates
Q0239 bamlanivimab-xxxx Eli Lilly Injection, bamlanivimab, 700 mg  $0.010 11/10/2020 – TBD
M0239 bamlanivimab-xxxx infusion Eli Lilly Intravenous infusion, bamlanivimab-xxxx, includes infusion and post administration monitoring $309.600 11/10/2020 – TBD
Q0243 casirivimab and imdevimab Regeneron Injection, casirivimab and imdevimab, 2400 mg $0.010 11/21/2020 – TBD
M0243 casirivi and imdevi infusion Regeneron intravenous infusion, casirivimab and imdevimab includes infusion and post administration monitoring $309.600 11/21/2020 – TBD

Are you using CPT 99072?

This relatively new CPT code is different to the 99070 normally used to report additional supplies. It can be used instead of 99070 to cover the additional supplies, materials, and clinical staff time required to support safe in-person patient interactions during the COVID-19 Public Health Emergency (PHE). Check with your payers to make sure they are covering the code prior to using it, and make sure you check the documentation guidelines. It is also easy to set up templates to quickly document the time you spend, and extra supplies used.