New CPT Codes for COVID-19 Vaccines

As COVID-19 clinical trials were reporting highly successful outcomes last summer, it became apparent that Current Procedural Terminology (CPT) codes needed to be created in order to track the various vaccines used, their efficacy and outcomes. CPT codes provide the “common language of medicine,” with each code representing a discrete device or drug (including vaccines) required for the performance of a medical service or procedure. The task of keeping CPT codes current, falls on the CPT Editorial Panel. And the panel recently released four new CPT codes for COVID-19 vaccines available in the US.

• 91300 for the Pfizer-BioNTech vaccine

• 91301 for the Moderna vaccine 

• 91302 for the AstraZeneca vaccine, which is not yet authorized for use in the US

• 91303 for the vaccine developed by Johnson & Johnson-owned Janssen Pharmaceuticals.

With these tools, the FDA, the Centers for Disease Control and Prevention (CDC), Centers for Medicare & Medicaid Services along with insurance carriers will be able to process and track vaccine efficacy and ultimately respond more efficiently to all the twists and turns that COVID-19 takes in the US

Ontash Systems uses CPT codes in its AI & Predictive Data Analytics software. Hospitals provide daily batch feeds of data for uninsured patients. The data is fed into the software, where it is matched against a predictive model of the ideal SSI and/or SSDI candidate patient. And as some of these patients are ultimately awarded “disability” by the Social Security Administration, the model is constantly refining its criteria and better able to predict which patients will qualify for SSI or SSDI. Once the patient is awarded SSI or SSDI, the hospital may invoice Medicaid and/or Medicare for services – instead of writing-off the debt to Charity Care. The four new CPT codes will eventually work their way into the Ontash predictive model and factor into determining disability candidacy