New Codes for COVID Booster Vaccine & Monoclonal Antibody Products

by  Wyn Staheli, Director of Content - innoviHealth
Aug 10th, 2021

As part of ongoing efforts to treat and prevent COVID-19, new vaccines and therapies continue to be added which require new codes for reporting. The following are some changes that have happened recently.

COVID Booster Vaccine Code

On July 30, 2021, the American Medical Association (AMA) announced the addition of a new CPT code (0003A) to report the administration of a third dose of the Pfizer-BioNTech COVID-19 vaccine. Although the FDA granted approval for the first two doses of this vaccine back in December of 2020, according to the AMA website, the code for reporting the third booster dose is effective upon receiving Emergency Use Authorization (EUA) or approval from the FDA. The AMA updated their Appendix Q to reflect this new code.

Monoclonal Antibody Product

Prior to this new booster code, on June 24, 2021, CMS announced new codes (Q0249, M0249, M0250) to report the use of Genentech’s Antibody Tocilizumab for the treatment of COVID-19. Unlike other monoclonal antibodies, which are only authorized to treat a patient with mild-to-moderate COVID-19 who has NOT been hospitalized, Tocilizumab’s EUA is for patients 2 years of age and older who are already hospitalized with severe COVID-19 illness.

Novavax Vaccine Code 

On May 4, 2021, the AMA released new codes to report the Novavax two-dose vaccine; code (91304) and its associated administration codes (0041A, 0042A). These codes will be effective upon receiving emergency use authorization from the FDA. However, Novavax recently stated that they won’t be submitting that request until the fourth quarter of this year even though they plan on requesting an emergency use listing from the World Health Organization (WHO) sometime in August.