How To Use CPT Code 91301

CPT 91301 describes the administration of a specific vaccine to prevent the patient from contracting COVID-19. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 91301?

CPT 91301 represents the administration of a vaccine that is designed to protect the patient from contracting COVID-19. This vaccine is specifically formulated to target the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is the virus responsible for causing COVID-19. The vaccine is administered through an intramuscular injection and contains a preservative-free dosage of 100 mcg/0.5 mL.

2. Official Description

The official description of CPT code 91301 is: ‘Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage, for intramuscular use.’ This code should be reported along with the appropriate administration codes (0011A, 0012A, 0013A) and should not be reported in conjunction with certain other administration codes (0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0134A, 0144A, 0164A).

3. Procedure

1. The healthcare provider administers the SARS-CoV-2 vaccine through an intramuscular injection.
2. The vaccine contains messenger ribonucleic acid (mRNA) that carries genetic information instructing the patient’s cells to produce the spike protein found on the surface of the coronavirus.
3. Once the spike protein is produced, it triggers an immune response in the patient’s body, helping to protect them from contracting COVID-19.
4. The vaccine also utilizes lipid nanoparticles (LNPs) as a delivery system to ensure effective distribution within the patient’s body.
5. The dosage of the vaccine is 100 mcg/0.5 mL.

4. Qualifying circumstances

CPT 91301 is appropriate for patients who are at risk of contracting COVID-19 and need to be protected through vaccination. The vaccine is specifically designed to target the SARS-CoV-2 virus, which is responsible for causing COVID-19. It is important to note that the administration of the vaccine should be performed by a qualified healthcare professional.

5. When to use CPT code 91301

CPT code 91301 should be used when administering the SARS-CoV-2 vaccine to patients who require protection against COVID-19. It is important to select the appropriate administration code based on the dose of the vaccine. For example, codes 0011A, 0012A, and 0013A represent the first, second, and third dose, respectively. It is also crucial to avoid reporting CPT code 91301 in conjunction with certain other administration codes (0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A, 0134A, 0144A, 0164A).

6. Documentation requirements

To support a claim for CPT code 91301, the healthcare provider must document the following information:

• Patient’s eligibility for the vaccine and the need for protection against COVID-19
• Specific details of the vaccine administered, including the manufacturer and dosage
• Date and time of the vaccine administration
• Route of administration (intramuscular)
• Signature of the healthcare provider performing the administration

7. Billing guidelines

When billing for CPT code 91301, ensure that the vaccine is administered by a qualified healthcare professional and that the appropriate administration codes are reported alongside it. It is important to follow the guidelines provided by the payer regarding the reporting of CPT code 91301 with other codes. Additionally, there are specific codes available for reporting the Moderna COVID-19 vaccine booster, which should be used accordingly.

8. Historical information

CPT code 91301 was added to the Current Procedural Terminology system on December 18, 2020. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider administering the first dose of the SARS-CoV-2 vaccine to a patient.
2. A nurse administering the second dose of the SARS-CoV-2 vaccine to a healthcare worker.
3. A pharmacist administering the third dose of the SARS-CoV-2 vaccine to an elderly patient.
4. A physician administering the Moderna COVID-19 vaccine booster with a dosage of 50 mcg/0.5 mL to a patient.
5. A healthcare provider administering the Moderna COVID-19 vaccine booster with a dosage of 50 mcg/0.25 mL to a pregnant patient.
6. A nurse administering the first dose of the SARS-CoV-2 vaccine to a patient with underlying health conditions.
7. A pharmacist administering the second dose of the SARS-CoV-2 vaccine to a patient in a long-term care facility.
8. A physician administering the third dose of the SARS-CoV-2 vaccine to a patient with a compromised immune system.
9. A healthcare provider administering the Moderna COVID-19 vaccine booster with a dosage of 50 mcg/0.5 mL to a patient with a history of allergies.