How To Use CPT Code 91313

CPT 91313 refers to the SARS-CoV-2 bivalent vaccine product administered by intramuscular injection to reduce the patient’s risk of contracting COVID-19. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 91313.

1. What is CPT 91313?

CPT 91313 is a code used to represent the SARS-CoV-2 bivalent vaccine product, which is administered by intramuscular injection to reduce the patient’s risk of contracting COVID-19. This vaccine is an mRNA-LNP vaccine, preservative-free, and has a dosage of 50 mcg/0.5 mL.

2. 91313 CPT code description

The official description of CPT code 91313 is: “Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use.”

3. Procedure

The 91313 procedure involves the following steps:

1. Preparation of the vaccine, ensuring it is the correct dosage (50 mcg/0.5 mL) and type (mRNA-LNP, spike protein, bivalent, preservative free).
2. Verification of the patient’s eligibility for the vaccine, including age, medical history, and any contraindications.
3. Obtaining informed consent from the patient or their legal representative.
4. Administration of the vaccine via intramuscular injection, typically in the deltoid muscle of the upper arm.
5. Monitoring the patient for any immediate adverse reactions or side effects.
6. Documenting the vaccine administration in the patient’s medical record, including the date, dosage, and any relevant observations.

4. Qualifying circumstances

Eligibility for CPT code 91313 services depends on several factors, including:

• Age: The vaccine may have different effective dates based on the patient’s age. It is essential to verify the patient’s age and the appropriate effective date before billing for this code.
• Medical history: Patients with certain medical conditions or a history of severe allergic reactions to vaccine components may not be eligible for the vaccine.
• Contraindications: The vaccine should not be administered to patients with known contraindications, such as a history of anaphylaxis to any component of the vaccine.

5. When to use CPT code 91313

It is appropriate to bill the 91313 CPT code when the vaccine is administered to a patient who meets the eligibility criteria and has no contraindications. The vaccine should be administered according to the recommended dosage and schedule, and the provider should ensure that the patient is monitored for any adverse reactions or side effects.

6. Documentation requirements

Documentation supporting a claim for CPT 91313 should include the following information:

• Patient’s demographic information, including age and medical history.
• Date of service and location of vaccine administration.
• Vaccine type, dosage, and lot number.
• Details of the administration, including the injection site and any observed reactions or side effects.
• Confirmation of informed consent from the patient or their legal representative.

7. Billing guidelines

When billing for CPT code 91313, it is essential to follow the appropriate guidelines and rules. For example, the vaccine product code 91313 should be reported with the administration code 0134A. Additionally, it is crucial not to report 91313 in conjunction with administration codes 0011A, 0012A, 0013A, 0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0144A, or 0164A.

8. Historical information

CPT 91313 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 91313

Five similar codes to CPT 91313 and how they differ are:

1. CPT 91300: This code represents the Pfizer-BioNTech COVID-19 vaccine, which is also an mRNA vaccine but has a different dosage and is not bivalent.
2. CPT 91301: This code is for the Moderna COVID-19 vaccine, another mRNA vaccine with a different dosage and not bivalent.
3. CPT 91302: This code is for the Janssen (Johnson & Johnson) COVID-19 vaccine, which is a viral vector vaccine and not an mRNA vaccine.
4. CPT 91311: This code represents a SARS-CoV-2 trivalent vaccine product, which contains mRNA components of three different strains of the virus.
5. CPT 91312: This code is for a SARS-CoV-2 quadrivalent vaccine product, which contains mRNA components of four different strains of the virus.

10. Examples

Here are 10 detailed examples of CPT code 91313 procedures:

1. A 45-year-old patient with no contraindications receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.
2. A 60-year-old patient with a history of hypertension receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.
3. A 30-year-old patient with a history of mild allergic reactions to other vaccines receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL after consultation with their healthcare provider.
4. A 50-year-old patient with a history of diabetes receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.
5. A 70-year-old patient with no contraindications receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.
6. A 55-year-old patient with a history of asthma receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.
7. A 65-year-old patient with a history of heart disease receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.
8. A 40-year-old patient with a history of autoimmune disease receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL after consultation with their healthcare provider.
9. A 35-year-old patient with no contraindications receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.
10. A 75-year-old patient with a history of chronic kidney disease receives the SARS-CoV-2 bivalent vaccine with a dosage of 50 mcg/0.5 mL.