Coding for Reimbursement
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FAQ
How is coding different for the 2024-2025 season compared to the previous COVID-19 2023-2024 vaccine formulation?
Moderna has created this coding tool to facilitate the selection of the appropriate CPT codes based on the Moderna vaccine and dose administered.
For commercially acquired COVID-19 vaccine product, such as Spikevax®, healthcare providers will need to bill for both the vaccine product as well as the administration service.
Use the CPT code that describes the vaccine product and dose administered consistent with the FDA label and CDC guidelines.
Use the new CPT code (90480) for the COVID-19 vaccine administration service regardless of the vaccine product, dose, or patient’s age.
Note, for COVID-19 vaccines administered and billed through a pharmacy claims system (NCPDP system), the 2024-2025 Moderna COVID-19 vaccines have different National Drug Codes (NDCs) from the 2023-2024 Moderna COVID-19 vaccines.
What code does Medicare use to describe COVID-19 vaccination administration?
Unlike for other covered Medicare Part B vaccinations such as influenza that use a HCPCS G code to describe the administration, for all COVID-19 vaccine administrations Medicare uses the newly implemented CPT code 90480 to describe the COVID-19 vaccination administration.
Where can I find the Medicare payment allowances for CPT code 90480?
For this information, please refer to information provided by the Centers for Medicare and Medicaid Services (CMS). Follow the link COVID-19 Vaccines & Monoclonal Antibodies for the national Medicare fee schedule published by CMS. This page lists the codes and payment amounts for Moderna COVID-19 vaccines; the related procedures and information on this page is expected to be updated in the July-August timeframe each year. For geographically adjusted payment rates for the vaccine administration code (CPT 90480) provided by CMS, please scroll down below the two charts to the appropriate year’s link for the Locality-Adjusted Payment rates that are expected to be updated each calendar year.
What do I do, we need to refile some claims from earlier in 2023 for government acquired vaccine?
Given the rapidly changing coding environment, Moderna has focused the Moderna coding tool on current commercially available product and the related CPT codes.
For your reference, please find a PDF of the codes used for government acquired vaccine product.