Moderna COVID-19 Vaccine
Coding for Reimbursement
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How is coding different for commercially acquired COVID-19 vaccines compared to the coding for government acquired vaccines used previously?
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.
What happened to all the CPT administration codes? What administration codes should I use?
Given the unique circumstances of the public health emergency (PHE) more specific CPT codes were required to track the COVID-19 vaccinations. This more specific coding nomenclature is no longer necessary after the sunsetting of the PHE and as we transition to commercially acquired COVID-19 vaccines.
As of August 14, 2023, the AMA implemented a COVID-19 immunization administration code to describe the administration service to be used with any COVID-19 vaccine. The AMA is also sunsetting all the product specific vaccine administration CPT codes used previously.
Use the newly implemented COVID-19 vaccine administration code (90480) to describe the administration service for any COVID-19 vaccine regardless of vaccine product, dose, or age.
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.
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.