How To Use CPT Code 91307

CPT 91307 refers to the SARS-CoV-2 vaccine product, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, 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 91307.

1. What is CPT 91307?

CPT 91307 is a medical billing code used to represent the administration of a specific SARS-CoV-2 (COVID-19) vaccine product. This vaccine is an mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, and is administered via intramuscular injection. The code is used by medical coders and billers to accurately document and bill for this specific vaccine product and its administration.

2. 91307 CPT code description

The official description of CPT code 91307 is: “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use.”

3. Procedure

1. Verify the patient’s eligibility for the vaccine based on age, medical history, and other relevant factors.
2. Obtain informed consent from the patient or their guardian.
3. Prepare the vaccine by reconstituting the diluent with the vaccine product according to the manufacturer’s instructions.
4. Draw the appropriate dosage (10 mcg/0.2 mL) into a sterile syringe.
5. Select an appropriate injection site, typically the deltoid muscle of the upper arm.
6. Clean the injection site with an alcohol swab and allow it to dry.
7. Administer the vaccine via intramuscular injection using proper technique.
8. Dispose of the used syringe and needle in a sharps container.
9. Document the vaccine administration in the patient’s medical record, including the date, time, dosage, and injection site.
10. Provide the patient with a vaccination record card and schedule a follow-up appointment for the second dose, if applicable.

4. Qualifying circumstances

Patients eligible to receive CPT code 91307 services include those who meet the age and health criteria established by the vaccine manufacturer and public health authorities. This may include pediatric patients, as well as adults with certain medical conditions or risk factors. Providers should consult the most current guidelines and recommendations from the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to determine eligibility for this specific vaccine product.

5. When to use CPT code 91307

It is appropriate to bill the 91307 CPT code when administering the specific SARS-CoV-2 vaccine product described in the code. This includes the mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use. Providers should ensure they are using the correct code for the specific vaccine product being administered, as there are separate codes for different formulations and dosages.

6. Documentation requirements

To support a claim for CPT 91307, providers must document the following information in the patient’s medical record:

• Patient’s demographic information, including age and any relevant medical history or risk factors.
• Date and time of vaccine administration.
• Vaccine product name, manufacturer, and lot number.
• Dosage administered (10 mcg/0.2 mL).
• Injection site (e.g., left deltoid).
• Name and title of the person administering the vaccine.
• Any adverse reactions or side effects experienced by the patient.
• Follow-up appointment date for the second dose, if applicable.

7. Billing guidelines

When billing for CPT code 91307, providers should follow the most current guidelines and rules established by the American Medical Association (AMA), the Centers for Medicare & Medicaid Services (CMS), and other relevant organizations. This may include using appropriate administration codes (e.g., 0071A, 0072A, 0073A, 0074A) and not reporting 91307 in conjunction with certain other administration codes. Providers should also ensure they are using the correct code for the specific vaccine product being administered, as there are separate codes for different formulations and dosages.

8. Historical information

CPT 91307 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 91307

Five similar codes to CPT 91307 and how they differentiate are:

1. CPT 91300: Represents the Pfizer-BioNTech COVID-19 vaccine/Comirnaty, which has a different formulation and dosage than CPT 91307.
2. CPT 91305: Represents the 30 mcg/0.3 mL dosage tris-sucrose formulation of the Pfizer-BioNTech COVID-19 vaccine, which has a higher dosage than CPT 91307.
3. CPT 91301: Represents the Moderna COVID-19 vaccine, which is a different vaccine product than CPT 91307.
4. CPT 91302: Represents the Janssen (Johnson & Johnson) COVID-19 vaccine, which is a different vaccine product than CPT 91307.
5. CPT 91303: Represents the AstraZeneca COVID-19 vaccine, which is a different vaccine product than CPT 91307.

10. Examples

Here are 10 detailed examples of CPT code 91307 procedures:

1. A 12-year-old patient receives their first dose of the SARS-CoV-2 vaccine described in CPT 91307 at a pediatric clinic.
2. An adult with a compromised immune system receives the CPT 91307 vaccine product as a booster dose at their primary care provider’s office.
3. A healthcare worker receives the CPT 91307 vaccine product as part of their employer’s vaccination program.
4. A college student receives the CPT 91307 vaccine product at a university health center.
5. A pregnant woman receives the CPT 91307 vaccine product at her obstetrician’s office after discussing the benefits and risks with her provider.
6. A patient with a history of severe allergic reactions to other vaccines receives the CPT 91307 vaccine product under close medical supervision.
7. A patient with a chronic medical condition receives the CPT 91307 vaccine product at a specialty clinic.
8. A patient participating in a clinical trial receives the CPT 91307 vaccine product as part of the study protocol.
9. A patient receives the CPT 91307 vaccine product at a pharmacy during a community vaccination event.
10. A patient receives the CPT 91307 vaccine product at a mobile vaccination clinic in a rural area with limited access to healthcare services.