How To Use CPT Code 91300

CPT 91300 refers to the SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 91300.

1. What is CPT 91300?

CPT 91300 is a medical billing code used to represent the administration of the SARS-CoV-2 (COVID-19) vaccine. This specific code refers to the mRNA-LNP vaccine, which is preservative-free and requires diluent reconstitution. The vaccine is administered intramuscularly, with a dosage of 30 mcg/0.3 mL.

2. 91300 CPT code description

The official description of CPT code 91300 is: “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use.”

3. Procedure

  1. Verify the patient’s eligibility for the COVID-19 vaccine.
  2. Obtain the vaccine vial and diluent.
  3. Reconstitute the vaccine by mixing the diluent with the vaccine vial.
  4. Draw the appropriate dosage (30 mcg/0.3 mL) into a syringe.
  5. Administer the vaccine intramuscularly, typically in the deltoid muscle of the upper arm.
  6. Document the vaccine administration, including the date, time, and site of injection.
  7. Monitor the patient for any adverse reactions for the recommended period.
  8. Provide the patient with a vaccination record card and schedule a follow-up appointment for the next dose, if applicable.

4. Qualifying circumstances

Individuals eligible to receive CPT code 91300 services are those who meet the criteria established by the Centers for Disease Control and Prevention (CDC) and the Advisory Committee on Immunization Practices (ACIP). Eligibility may vary based on factors such as age, occupation, underlying health conditions, and the current phase of vaccine distribution. It is essential to stay updated on the latest guidelines and recommendations from public health authorities.

5. When to use CPT code 91300

It is appropriate to bill the 91300 CPT code when administering the COVID-19 vaccine that matches the description of this code. This includes the Pfizer-BioNTech COVID-19 vaccine/Comirnaty, but not the Pfizer-BioNTech tris-sucrose formulation (91305). Ensure that the vaccine being administered is the mRNA-LNP, spike protein, preservative-free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use.

6. Documentation requirements

Proper documentation is crucial to support a claim for CPT 91300. This includes:

  • Patient’s demographic information and eligibility for the vaccine.
  • Vaccine manufacturer, lot number, and expiration date.
  • Date, time, and site of vaccine administration.
  • Dosage administered (30 mcg/0.3 mL).
  • Provider’s name and credentials.
  • Any adverse reactions observed and actions taken, if applicable.
  • Follow-up appointment information for the next dose, if applicable.

7. Billing guidelines

When billing for CPT code 91300, it is essential to follow the appropriate guidelines and rules. This includes reporting the vaccine product code (91300) along with the corresponding administration codes based on the dose (0001A-0004A). Do not report CPT 91300 in conjunction with administration codes for other COVID-19 vaccines, such as 0051A, 0052A, 0053A, 0054A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0124A, 0154A, 0173A, or 0174A.

8. Historical information

CPT 91300 was added to the Current Procedural Terminology system on December 11, 2020. There have been no updates to this code since its addition.

9. Similar codes to CPT 91300

Five similar codes to CPT 91300 and how they differ are:

  • CPT 91301: This code represents the Moderna COVID-19 vaccine, which is also an mRNA-LNP vaccine but has a different dosage (100 mcg/0.5 mL).
  • CPT 91302: This code is for the AstraZeneca COVID-19 vaccine, which uses a viral vector platform instead of mRNA-LNP.
  • CPT 91303: This code refers to the Janssen (Johnson & Johnson) COVID-19 vaccine, another viral vector-based vaccine with a single-dose regimen.
  • CPT 91304: This code is for the Novavax COVID-19 vaccine, which uses a protein subunit platform and requires two doses.
  • CPT 91305: This code represents the Pfizer-BioNTech tris-sucrose formulation, which is a different formulation of the Pfizer-BioNTech COVID-19 vaccine.

10. Examples

  1. A 65-year-old patient with underlying health conditions receives their first dose of the Pfizer-BioNTech COVID-19 vaccine (CPT 91300 and 0001A).
  2. A healthcare worker receives their second dose of the Pfizer-BioNTech COVID-19 vaccine (CPT 91300 and 0002A).
  3. An essential worker receives their first dose of the Pfizer-BioNTech COVID-19 vaccine (CPT 91300 and 0001A).
  4. A 45-year-old patient with no underlying health conditions receives their first dose of the Pfizer-BioNTech COVID-19 vaccine during a mass vaccination event (CPT 91300 and 0001A).
  5. A college student receives their second dose of the Pfizer-BioNTech COVID-19 vaccine at a university clinic (CPT 91300 and 0002A).
  6. A patient receives their first dose of the Pfizer-BioNTech COVID-19 vaccine at a pharmacy (CPT 91300 and 0001A).
  7. A teacher receives their second dose of the Pfizer-BioNTech COVID-19 vaccine at a school-based vaccination clinic (CPT 91300 and 0002A).
  8. An individual receives their first dose of the Pfizer-BioNTech COVID-19 vaccine at a mobile vaccination unit (CPT 91300 and 0001A).
  9. A patient receives their third dose of the Pfizer-BioNTech COVID-19 vaccine due to being immunocompromised (CPT 91300 and 0003A).
  10. An individual receives a booster dose of the Pfizer-BioNTech COVID-19 vaccine as recommended by public health authorities (CPT 91300 and 0004A).

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