How To Use CPT Code 91311

CPT 91311 refers to the SARS-CoV-2 (COVID-19) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use. This article will discuss the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 91311.

1. What is CPT 91311?

CPT 91311 is a code used to represent the SARS-CoV-2 (COVID-19) vaccine product, specifically the mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, administered via intramuscular injection. This vaccine aims to reduce the patient’s risk of contracting COVID-19 by triggering an immune response against the virus.

2. 91311 CPT code description

The official description of CPT code 91311 is: “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use.”

3. Procedure

The 91311 procedure involves the following steps:

1. Preparation of the vaccine, ensuring the correct dosage of 25 mcg/0.25 mL is used.
2. Selection of the appropriate injection site, typically the deltoid muscle of the upper arm.
3. Cleansing of the injection site with an alcohol swab.
4. Administration of the vaccine via intramuscular injection using a sterile needle and syringe.
5. Disposal of the used needle and syringe in a sharps container.
6. Monitoring the patient for any immediate adverse reactions or side effects.

4. Qualifying circumstances

Individuals eligible to receive CPT code 91311 services are those who meet the criteria set by the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) for COVID-19 vaccination. These criteria may include age, occupation, underlying health conditions, and other factors that put individuals at higher risk for severe illness from COVID-19. It is essential for healthcare providers to stay updated on the latest eligibility guidelines and recommendations from public health authorities.

5. When to use CPT code 91311

It is appropriate to bill the 91311 CPT code when administering the specified COVID-19 vaccine to eligible individuals, as per the CDC and FDA guidelines. This code should be used for the vaccine product only and not for the administration of the vaccine, which requires separate codes (e.g., 0111A for the first dose administration and 0112A for the second dose administration).

6. Documentation requirements

To support a claim for CPT 91311, the following information needs to be documented:

• Patient’s demographic information, including name, date of birth, and contact details.
• Patient’s medical history and any contraindications to receiving the vaccine.
• Date of vaccine administration.
• Vaccine manufacturer, lot number, and expiration date.
• Injection site and dosage administered.
• Name and credentials of the healthcare professional administering the vaccine.
• Any adverse reactions or side effects observed during or after the vaccination.

7. Billing guidelines

When billing for CPT code 91311, it is crucial to follow the appropriate guidelines and rules. This includes using the correct administration codes (e.g., 0111A for the first dose and 0112A for the second dose) in conjunction with the vaccine product code. Additionally, do not report CPT 91311 with administration codes that are not applicable, such as 0011A, 0012A, 0013A, 0064A, 0091A, 0092A, 0093A, 0094A, 0134A, 0144A, or 0164A.

8. Historical information

CPT 91311 was added to the Current Procedural Terminology system on June 17, 2022. There have been no updates to the code since its addition.

9. Similar codes to CPT 91311

Five similar codes to CPT 91311 and how they differ are as follows:

1. CPT 91300: This code represents the Pfizer-BioNTech COVID-19 vaccine, which has a different dosage and formulation than the vaccine represented by CPT 91311.
2. CPT 91320: This code is for the Novavax COVID-19 vaccine, which uses a different technology (protein subunit) compared to the mRNA-LNP technology in CPT 91311.
3. CPT 91321: This code is for the AstraZeneca COVID-19 vaccine, which uses a viral vector technology instead of the mRNA-LNP technology in CPT 91311.
4. CPT 91322: This code is for the Janssen (Johnson & Johnson) COVID-19 vaccine, which also uses viral vector technology and requires only one dose, unlike the two-dose regimen of the vaccine represented by CPT 91311.
5. CPT 91323: This code is for the Sanofi-GSK COVID-19 vaccine, which uses protein subunit technology and has a different dosage and formulation than the vaccine represented by CPT 91311.

10. Examples

Here are 10 detailed examples of CPT code 91311 procedures:

1. A 65-year-old patient with diabetes receives the first dose of the COVID-19 vaccine represented by CPT 91311 at a vaccination clinic.
2. A healthcare worker receives the second dose of the COVID-19 vaccine represented by CPT 91311 at their workplace.
3. A 45-year-old patient with a history of heart disease receives the first dose of the COVID-19 vaccine represented by CPT 91311 at their primary care physician’s office.
4. A teacher receives the second dose of the COVID-19 vaccine represented by CPT 91311 at a mass vaccination site.
5. An immunocompromised patient receives the first dose of the COVID-19 vaccine represented by CPT 91311 at a specialty clinic.
6. A pregnant patient receives the second dose of the COVID-19 vaccine represented by CPT 91311 at an obstetrics and gynecology clinic.
7. A patient with a history of severe allergic reactions to vaccines receives the first dose of the COVID-19 vaccine represented by CPT 91311 under close observation at a hospital.
8. A patient with a history of autoimmune disease receives the second dose of the COVID-19 vaccine represented by CPT 91311 at a rheumatology clinic.
9. A patient with a history of cancer receives the first dose of the COVID-19 vaccine represented by CPT 91311 at an oncology clinic.
10. A patient with a history of respiratory illness receives the second dose of the COVID-19 vaccine represented by CPT 91311 at a pulmonology clinic.