September 22, 2023
The U.S. Food and Drug Administration (FDA) recently approved and authorized for emergency use updated COVID-19 vaccines formulated to more closely target currently circulating variants and to provide better protection against serious consequences of COVID-19, including hospitalization and death. Federal health officials have recommended all Americans ages 6 months and up get the new round of vaccines.
The American Medical Association (AMA) also recently published new Current Procedural Terminology (CPT®) codes that consolidate over 50 previous codes and greatly streamline the reporting of COVID-19 immunizations. The AMA CPT Editorial Panel approved the addition of new product codes 91318-91322 to identify monovalent vaccine product (Pfizer, Moderna) for immunization against COVID-19 as well as a single administration code (90480) for administration of new and existing COVID-19 vaccines.
All existing CPT codes that describe COVID-19 vaccine products and associated administration codes that end in “A” for products that are no longer authorized will be deleted effective Nov. 1, 2023. Physicians should immediately stop using the old codes.
To minimize the risk of vaccine administration errors, the California Department of Public Health is directing providers to dispose of all bivalent mRNA COVID-19 vaccines, regardless of expiration dates.
Note: FDA is still reviewing the 2023-2024 Novavax vaccine. The original formulation of Novavax vaccine may still be administered if it is determined that the individual should not wait for a 2023-2024 Novavax COVID-19 vaccine or receive a 2023-2024 mRNA COVID-19 vaccine.
How Providers Can Obtain Updated Vaccines
While private insurance plans and government payors are required to cover the new monovalent vaccines from Pfizer and Moderna, the government is moving shots to the commercial market. This means manufacturers will sell their new vaccines directly to health-care providers. Previously, the federal government purchased COVID-19 vaccines directly from manufacturers at a discount to distribute to all Americans for free.
The California Medical Association is currently reaching out to payors about when their systems will be ready to process and pay the new vaccines. As more details become available, the California Medical Association (CMA) COVID-19 Vaccine Toolkit for Medical Practices will be updated to reflect the latest information.
In the commercial market, the Moderna vaccine can be ordered through McKesson, Cardinal, and AmeriSource Bergen distributors, or directly from Moderna. The Pfizer vaccine can be purchased through wholesalers or directly from Pfizer for minimum quantities.
Patients Experiencing Unexpected Coverage Denials
According to recent news reports, some consumers are having difficulty accessing COVID-19 vaccines, including unexpected insurance coverage denials at the point of service. The Centers for Medicare and Medicaid Services (CMS) says it has been in “close contact with the plans about these transitions for months,” and is reaching out again to ensure that their systems are “up-to-date and prepared to meet their obligations to provide coverage of COVID-19 vaccines for participants, beneficiaries and enrollees.”
In California, payors are still required to cover COVID-19 testing, immunization and related services. CMA is currently collecting information from payors about their readiness to accept claims under the new CPT codes. We will publish an update when we have more details.
CDC’s Bridge Access Program is still providing no-cost COVID-19 vaccines to adults without health insurance and adults whose insurance does not cover all COVID-19 vaccine costs. No-cost COVID-19 vaccines through this program will be available until December 31, 2024. (Bridge Access Program Providers can still utilize myCAvax for their vaccine needs.)
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