How To Use CPT Code 91305

CPT 91305 is a code for the SARS-CoV-2 vaccine product, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, 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 91305.

1. What is CPT 91305?

CPT 91305 is a code used to represent the administration of a specific SARS-CoV-2 (COVID-19) vaccine product. This vaccine is an mRNA-LNP vaccine with a tris-sucrose formulation, administered intramuscularly at a dosage of 30 mcg/0.3 mL. The code is used by medical coders and billers to document and bill for the vaccine administration.

2. 91305 CPT code description

The official description of CPT code 91305 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, tris-sucrose formulation, for intramuscular use.”

3. Procedure

1. Verify the patient’s eligibility for the vaccine based on age, medical history, and other factors.
2. Obtain informed consent from the patient or their legal representative.
3. Prepare the vaccine by following the manufacturer’s instructions for reconstitution and dilution, if necessary.
4. Administer the vaccine intramuscularly, typically in the deltoid muscle of the upper arm, using a sterile needle and syringe.
5. Document the vaccine administration, including the date, time, dosage, and site of injection.
6. Monitor the patient for any immediate adverse reactions or side effects.
7. Provide the patient with a vaccination record card and schedule any necessary follow-up doses.

4. Qualifying circumstances

Individuals eligible to receive CPT code 91305 services include those who meet the age and health criteria established by the vaccine manufacturer and public health authorities. This may include individuals with certain underlying health conditions, essential workers, or those in specific age groups. Eligibility may also depend on the availability of the vaccine and the current phase of the vaccination rollout in a particular region.

5. When to use CPT code 91305

It is appropriate to bill the 91305 CPT code when administering the specific SARS-CoV-2 vaccine product described by the code. This includes the mRNA-LNP vaccine with a tris-sucrose formulation, administered intramuscularly at a dosage of 30 mcg/0.3 mL. The code should be used for each dose of the vaccine administered to a patient.

6. Documentation requirements

Documentation supporting a claim for CPT 91305 should include the following information:

• Patient’s demographic information, including name, date of birth, and contact information.
• Patient’s medical history, including any contraindications or precautions related to the vaccine.
• Details of the vaccine administration, such as date, time, dosage, and site of injection.
• Manufacturer, lot number, and expiration date of the vaccine.
• Documentation of informed consent from the patient or their legal representative.
• Any observed adverse reactions or side effects following the vaccine administration.
• Follow-up appointment information for subsequent doses, if applicable.

7. Billing guidelines

When billing for CPT code 91305, it is important to follow the appropriate guidelines and rules. This includes using the correct administration codes based on the dose (e.g., 0051A-0054A for the first, second, third, and booster doses, respectively). Additionally, do not report CPT 91305 in conjunction with administration codes that are not applicable to this specific vaccine product (e.g., 0001A, 0002A, 0003A, etc.).

8. Historical information

CPT 91305 was added to the Current Procedural Terminology system on October 29, 2021. There have been no updates to the code since its addition.

9. Similar codes to CPT 91305

Five similar codes to CPT 91305 and how they differ are:

1. CPT 91300: Represents the Pfizer-BioNTech COVID-19 vaccine/Comirnaty, which is a different formulation than the tris-sucrose formulation in CPT 91305.
2. CPT 91301: Represents the Moderna COVID-19 vaccine, which is a different manufacturer and formulation than CPT 91305.
3. CPT 91302: Represents the Janssen (Johnson & Johnson) COVID-19 vaccine, which is a different type of vaccine (adenovirus vector) and manufacturer than CPT 91305.
4. CPT 91303: Represents the AstraZeneca COVID-19 vaccine, which is a different type of vaccine (adenovirus vector) and manufacturer than CPT 91305.
5. CPT 91304: Represents the Novavax COVID-19 vaccine, which is a different type of vaccine (protein subunit) and manufacturer than CPT 91305.

10. Examples

Here are 10 detailed examples of CPT code 91305 procedures:

1. A 65-year-old patient with a history of hypertension receives their first dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
2. A 30-year-old healthcare worker receives their second dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
3. A 50-year-old patient with diabetes receives their first dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
4. A 40-year-old teacher receives their second dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
5. A 75-year-old patient with a history of heart disease receives their first dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
6. A 60-year-old patient with a history of cancer receives their second dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
7. A 45-year-old grocery store worker receives their first dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
8. A 55-year-old patient with a history of asthma receives their second dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
9. A 70-year-old patient with a history of chronic kidney disease receives their first dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.
10. A 35-year-old public transportation worker receives their second dose of the mRNA-LNP, tris-sucrose formulation COVID-19 vaccine.