Updated Medicare CPT Codes and Payment for Additional COVID-19 Vaccine Doses

On August 12, the Food and Drug Administration (FDA) amended the emergency use authorizations (EUAs) for the Pfizer-BioNTech and Moderna COVID-19 vaccines, authorizing the use of an additional dose in immunocompromised individuals. The new authorizations allow for a third dose to be given at least 28 days following the two-dose regimen of the same vaccine to those over the age of 18 (ages 12 and older for Pfizer-BioNTech) who are solid organ transplant recipients or have certain conditions that are an equivalent level of immunocompromise. After review, the Centers of Disease Control and Prevention (CDC) officially recommended that people with moderately to severely weakened immune systems receive the additional shot. CDC’s independent advisory panel, the Advisory Committee on Immunization Practices outlined clinical considerations regarding the additional dose. Urban Indians should talk to their healthcare provider about their medical condition, and whether getting an additional dose is appropriate for them.

Effective August 12, the Medicare CPT code for the Pfizer vaccine is 0003A and the CPT code for the Moderna vaccine is 0013A. CMS has also authorized payment for the administration of additional doses of the COVID-19 vaccine, which will be reimbursed at $40.

For more information on Medicare COVID-19 codes click here.

For more information on Medicare COVID-19 payments click here.