How To Use CPT Code 91315

CPT 91315 describes the administration of a bivalent vaccine for the prevention of COVID-19 caused by the SARS-CoV-2 virus. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 91315?

CPT 91315 represents the administration of a bivalent vaccine designed to protect against COVID-19. This vaccine is specifically formulated to target the spike proteins of the SARS-CoV-2 virus. It is administered via intramuscular injection and does not contain any preservatives. The dosage of the vaccine is 10 mcg/0.2 mL, and it is reconstituted with a tris-sucrose formulation.

2. Official Description

The official description of CPT code 91315 is: ‘Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use.’

3. Procedure

1. The healthcare provider prepares the vaccine by reconstituting the diluent with the bivalent spike protein.
2. The patient is positioned appropriately for intramuscular injection.
3. The healthcare provider administers the vaccine into the muscle using a sterile needle and syringe.
4. After the injection, the healthcare provider disposes of the used needle and syringe in a proper sharps container.
5. The patient may be observed for a short period to monitor for any immediate adverse reactions.

4. Qualifying circumstances

CPT 91315 is used for patients who are at risk of contracting COVID-19 and require vaccination. It is important to note that this code should not be reported in conjunction with certain administration codes, as specified in the notes. The vaccine is suitable for individuals who meet the eligibility criteria for COVID-19 vaccination, as determined by public health guidelines.

5. When to use CPT code 91315

CPT code 91315 should be used when administering the bivalent COVID-19 vaccine to eligible patients. It is important to follow the guidelines provided by public health authorities and ensure that the patient meets the criteria for vaccination. This code should not be used in conjunction with certain other administration codes, as specified in the notes.

6. Documentation requirements

To support a claim for CPT 91315, the healthcare provider must document the following information:

• Patient’s eligibility for COVID-19 vaccination
• Date and time of vaccine administration
• Specific details of the vaccine administered, including the dosage and formulation
• Route of administration (intramuscular)
• Signature of the healthcare provider administering the vaccine

7. Billing guidelines

When billing for CPT 91315, ensure that the vaccine is administered by a qualified healthcare provider and that the documentation requirements are met. It is important to follow the guidelines provided by public health authorities and any specific billing requirements from payers. Additionally, be aware of the restrictions on reporting this code with certain other administration codes, as specified in the notes.

8. Historical information

CPT 91315 was added to the Current Procedural Terminology system on October 12, 2022. As of now, there have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider administers the bivalent COVID-19 vaccine to a patient who meets the eligibility criteria for vaccination.
2. A nurse administers the bivalent COVID-19 vaccine to a patient at a vaccination clinic.
3. A pharmacist administers the bivalent COVID-19 vaccine to a patient at a pharmacy.
4. A healthcare provider administers the bivalent COVID-19 vaccine to a patient in a long-term care facility.
5. A mobile vaccination team administers the bivalent COVID-19 vaccine to individuals in a rural community.
6. A healthcare provider administers the bivalent COVID-19 vaccine to a patient in a hospital setting.
7. A nurse administers the bivalent COVID-19 vaccine to a patient in a primary care clinic.
8. A healthcare provider administers the bivalent COVID-19 vaccine to a patient in a workplace vaccination program.
9. A pharmacist administers the bivalent COVID-19 vaccine to a patient in a retail pharmacy.
10. A healthcare provider administers the bivalent COVID-19 vaccine to a patient in a community vaccination center.