How To Use CPT Code 91312

CPT 91312 is a code for the SARS-CoV-2 bivalent vaccine product, specifically the Pfizer-BioNTech COVID-19 bivalent vaccine with a 30 mcg/0.3 mL dosage. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 91312.

1. What is CPT 91312?

CPT 91312 is a code used to represent the SARS-CoV-2 bivalent vaccine product, which is administered to reduce the patient’s risk of contracting COVID-19. This code specifically refers to the Pfizer-BioNTech COVID-19 bivalent vaccine with a 30 mcg/0.3 mL dosage. The vaccine is an mRNA-LNP vaccine, preservative-free, and administered via intramuscular injection.

2. 91312 CPT code description

The official description of CPT code 91312 is: “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use.”

3. Procedure

The 91312 procedure involves the following steps:

1. Patient eligibility is confirmed, ensuring they meet the criteria for receiving the bivalent vaccine.
2. The healthcare provider prepares the vaccine by following the manufacturer’s guidelines for reconstitution and handling.
3. The patient’s skin is cleaned at the injection site, typically the deltoid muscle of the upper arm.
4. The healthcare provider administers the 30 mcg/0.3 mL dosage of the vaccine via intramuscular injection.
5. Post-vaccination, the patient is monitored for any immediate adverse reactions or side effects.
6. Documentation of the vaccine administration is completed, including the date, time, and any relevant patient information.

4. Qualifying circumstances

Individuals eligible to receive CPT code 91312 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 the Pfizer-BioNTech COVID-19 bivalent vaccine. This may include individuals aged 12 and older, depending on the current recommendations and guidelines. Healthcare providers should consult the most recent guidelines to determine patient eligibility for the vaccine.

5. When to use CPT code 91312

It is appropriate to bill the 91312 CPT code when a healthcare provider administers the Pfizer-BioNTech COVID-19 bivalent vaccine with a 30 mcg/0.3 mL dosage to an eligible patient. This code should be used to represent the vaccine product itself, while a separate administration code (such as 0124A) should be used to report the actual administration of the vaccine.

6. Documentation requirements

When billing for CPT 91312, healthcare providers must document the following information to support the claim:

• Patient’s demographic information, including name, date of birth, and insurance information.
• Date and time of the vaccine administration.
• Vaccine manufacturer, lot number, and expiration date.
• Injection site (e.g., left or right deltoid muscle).
• Name, title, and credentials of the healthcare provider administering the vaccine.
• Any observed adverse reactions or side effects.

7. Billing guidelines

When billing for CPT code 91312, healthcare providers should follow these guidelines:

• Report CPT 91312 with the appropriate administration code (e.g., 0124A).
• Do not report CPT 91312 in conjunction with other administration codes, such as 0001A, 0002A, 0003A, 0004A, 0051A, 0052A, 0053A, 0054A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A, 0154A, 0173A, or 0174A.
• Ensure all required documentation is complete and accurate to support the claim.

8. Historical information

CPT 91312 was added to the Current Procedural Terminology system on August 31, 2022. There have been no updates to the code since its addition.

9. Similar codes to CPT 91312

Five similar codes to CPT 91312 and how they differ are:

• CPT 91300: Represents the Pfizer-BioNTech COVID-19 vaccine with a 30 mcg/0.3 mL dosage, but not the bivalent version.
• CPT 91301: Represents the Moderna COVID-19 vaccine with a 100 mcg/0.5 mL dosage.
• CPT 91302: Represents the Janssen (Johnson & Johnson) COVID-19 vaccine with a 5×10^10 viral particles/0.5 mL dosage.
• CPT 91303: Represents the Novavax COVID-19 vaccine with a 5 mcg/0.5 mL dosage.
• CPT 91304: Represents the AstraZeneca COVID-19 vaccine with a 5×10^10 viral particles/0.5 mL dosage.

10. Examples

Here are 10 detailed examples of CPT code 91312 procedures:

1. A 45-year-old patient receives the Pfizer-BioNTech COVID-19 bivalent vaccine as a booster dose after previously completing the primary series.
2. A 16-year-old patient receives the Pfizer-BioNTech COVID-19 bivalent vaccine as their first dose in the primary series.
3. A healthcare worker receives the Pfizer-BioNTech COVID-19 bivalent vaccine as a booster dose to maintain protection against COVID-19.
4. An immunocompromised patient receives the Pfizer-BioNTech COVID-19 bivalent vaccine as an additional dose to enhance their immune response.
5. A 30-year-old patient receives the Pfizer-BioNTech COVID-19 bivalent vaccine as their second dose in the primary series.
6. A teacher receives the Pfizer-BioNTech COVID-19 bivalent vaccine as a booster dose to maintain protection in a high-risk environment.
7. A pregnant patient receives the Pfizer-BioNTech COVID-19 bivalent vaccine as a booster dose after consulting with their healthcare provider.
8. A patient with a history of severe allergic reactions to other vaccines receives the Pfizer-BioNTech COVID-19 bivalent vaccine after a risk assessment by their healthcare provider.
9. A patient who previously received the Moderna COVID-19 vaccine receives the Pfizer-BioNTech COVID-19 bivalent vaccine as a booster dose based on current guidelines.
10. A patient who previously received the Janssen (Johnson & Johnson) COVID-19 vaccine receives the Pfizer-BioNTech COVID-19 bivalent vaccine as a booster dose based on current guidelines.