Big changes will streamline CPT coding for immunization – American Medical Association

Significant changes in the Current Procedural Terminology(CPT) code setfor immunizations reflect the changing nature of how COVID-19 is being addressed as actions transition from a public health emergency response to combatting emerging variants much like the flu.

One significant change involves the consolidationof more than 50 previous codes tostreamline reporting of immunizations for COVID-19. A new vaccine-administration code,90480, was approved for reporting the administration of any COVID-19 vaccine for any patient. This replaces all previously approved, product-specific vaccine-administration codes.

From a public health perspective, there was great initial value in tracking each individual vaccine during the public health emergency, With the end of the public health emergency, there is no longer a need for the coding granularity of individual administration codes for every vaccine product.

Additionally, the Vaccines and Related Biological Products Advisory Committee (VRBPAC), an advisory group of the FDA, recommended that the COVID-19 vaccine for the 20232024 vaccination season be a monovalent vaccine that contains the XBB.1.5 strain, and noted that a number of COVID-19 vaccine products will no longer be recommended for use. The streamlined structure brings greater alignment between CPT and the current COVID-19 vaccine reporting environment.

The new coding system will allow for new vaccines for new variants whenever they come up without having to do a new code, said Samuel Le Church, MD, MPH, a member of the CPT Editorial Panel and vice-chair of its Immunization Coding Caucus.

Dr. Church, president of the Georgia Academy of Family Physicians, spoke at the annual AMA CPT and RBRVS Annual Symposium, held virtually this year.

The CPT Editorial Panel approved five new COVID-19 vaccine product codes and one administration code in August 2023. These new COVID-19 codes replaced all previously approved specific COVID-19 product and administration codes, except for vaccine product code 91304 for the Novavax vaccine.

Specific information to assist with proper code selection of the more than 50 COVID-related vaccine product and administration codes were contained in Appendix Q of the CPT code set. With the removal of those COVID-19 codes, Appendix Q was also deleted in November.

Some vaccine and immune globulin products are assigned a code in anticipation of eventual approval by the Food and Drug Administration. These codes are marked with a lightning bolt symbol in the Category I Immunization code descriptors (PDF).

The new codes added for 2024 include three Pfizer-product codes and reflect vaccine concentrations developed for different age groups:

There are also two new Moderna-product codes:

My hope is that all these changes will dramatically simplify your coding experience when dealing with the COVID-vaccine products, Dr. Church said.

Learn more with the AMA about the most current COVID-19 CPT vaccine and immunization codes.

Typically, vaccine codes are electronically published July 1 and January 1, though some may require expedited release due to public health concerns as was the case with the vaccines for COVID-19 and respiratory syncytial virus (RSV).

After the final approval is done, then that lightning bolt will be taken away, Dr. Church said.

Reflecting all these developments, the CPT vaccine early release schedule will now be known as the immunization early release schedule and will include vaccines/toxoids, immune globulins and serum or recombinant products.

There are a lot of changes that are happening in the world of immunization, so it was a bit restrictive to have it be a vaccine early release policy, so we expanded that, Dr. Church explained.

Weve got a lot going on in the RSV world, he added.

This includes two new seasonal RSV monoclonal antibody immunization pediatric codes for children less than 24 months of age with dosage based on the childs weight, as well as two new administration codes for these products that are differentiated by the inclusion of counseling:

Additionally, three vaccine codes were created and associated with use in the adult population:

These codes were developed to provide better tracking to support data-driven planning and allocation, and to track patient outcomes.

Also new are:

The CPT 2024 Professional Edition and CPT Changes 2024: An Insiders View are available from theAMA Storefronton Amazon.

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Big changes will streamline CPT coding for immunization - American Medical Association