How To Use CPT Code 91303

CPT 91303 describes the administration of a DNA-based vaccine for the prevention of COVID-19. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 91303?

CPT 91303 represents the administration of a DNA-based vaccine that targets the spike protein of the SARS-CoV-2 virus, which causes COVID-19. This vaccine is given via intramuscular injection and is preservative-free. The dosage of the vaccine is 5×10¹⁰ viral particles/0.5 mL.

2. Official Description

The official description of CPT code 91303 is: ‘Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5×10¹⁰ viral particles/0.5 mL dosage, for intramuscular use.’

3. Procedure

1. The healthcare provider administers the DNA-based vaccine to the patient via intramuscular injection.
2. The vaccine contains a modified adenovirus type 26 vector that carries the gene for the spike protein of the SARS-CoV-2 virus.
3. After injection, the adenoviruses enter cells and instruct them to produce spike proteins.
4. The spike proteins trigger an immune response in the patient’s body, helping to protect against COVID-19.
5. The dosage of the vaccine is 5×10¹⁰ viral particles/0.5 mL.

4. Qualifying circumstances

CPT 91303 is used for patients who are at risk of contracting COVID-19 and need vaccination to reduce their risk. The vaccine is administered by a healthcare provider and is suitable for individuals who meet the eligibility criteria for COVID-19 vaccination. The patient should not have any contraindications to receiving the vaccine.

5. When to use CPT code 91303

CPT code 91303 should be used when a healthcare provider administers the DNA-based vaccine for COVID-19 prevention. It is important to ensure that the vaccine administered matches the specific product described by CPT code 91303. This code should be reported for each dose of the vaccine given to the patient.

6. Documentation requirements

To support a claim for CPT 91303, the healthcare provider must document the following information:

• Patient’s eligibility for COVID-19 vaccination
• Date of administration
• Route of administration (intramuscular)
• Dosage of the vaccine (5×10¹⁰ viral particles/0.5 mL)
• Signature of the healthcare provider administering the vaccine

7. Billing guidelines

When billing for CPT 91303, ensure that the vaccine administered matches the description provided by the code. It is important to use the appropriate administration codes (0031A for a single dose and 0034A for the booster dose) in conjunction with CPT 91303. Report CPT 91303 separately from other codes and follow any additional guidelines provided by payers or regulatory bodies.

8. Historical information

CPT 91303 was added to the Current Procedural Terminology system on February 27, 2021. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider administering the DNA-based COVID-19 vaccine to a patient at a vaccination clinic.
2. A nurse giving the intramuscular injection of the DNA-based COVID-19 vaccine to an eligible individual at a hospital.
3. A pharmacist administering the DNA-based COVID-19 vaccine to a patient at a community pharmacy.
4. A healthcare provider providing the DNA-based COVID-19 vaccine to a patient in a long-term care facility.
5. A physician administering the DNA-based COVID-19 vaccine to a patient during a routine office visit.
6. A healthcare provider giving the intramuscular injection of the DNA-based COVID-19 vaccine to a patient at a mobile vaccination clinic.
7. A nurse practitioner administering the DNA-based COVID-19 vaccine to a patient at a school vaccination event.
8. A healthcare provider providing the DNA-based COVID-19 vaccine to a patient at a drive-through vaccination site.
9. A pharmacist giving the intramuscular injection of the DNA-based COVID-19 vaccine to an eligible individual at a retail pharmacy.
10. A healthcare provider administering the DNA-based COVID-19 vaccine to a patient at a mass vaccination center.