Code 0174A For Patients Ages 6 Months To 4 Years

Code-0174A-For-Patients-Ages-6-Months-To-4-Years

On March 14, 2023, the U.S. Food and Drug Administration amended the emergency use authorization (EUA) of the bivalent Pfizer-BioNTech COVID-19 vaccine to allow providers to administer a booster to certain young patients. As a result, on March 17, the American Medical Association (AMA) released a new CPT® code for booster administration. Here’s what you need to know.

Report 0174A With 91317

The new code for booster administration is 0174A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; booster dose.

You must pair administration code 0174A with the correct vaccine product code, which is 91317 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use.

Both code descriptors include that the vaccine is bivalent (protects against more than one strain of the virus) and has a 3 mcg/0.2 mL dosage.

Know Who Is Eligible for the Booster

According to the EUA, providers may administer a single booster in patients ages 6 months to 4 years at least two months after they complete a primary vaccination with three doses of the monovalent (single strain) Pfizer vaccine.

From a coding perspective, this means the patient completed the primary vaccine series of 91308 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use.

The relevant admin codes for the three-dose monovalent series are 0081A (first dose), 0082A (second dose), and 0083A (third dose).

What About 0173A?

To allow for the creation of 0174A, the AMA changed the comma before “third dose” to a semicolon in 0173A Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose.

This change allows 0173A and 0174A to share the portions of their descriptors before the semicolon, creating a code family. Both codes apply to administration of Pfizer’s bivalent vaccine with a 3 mcg/0.2 mL dosage.

Remember, however, that the EUA says the booster (0174A) is for patients who completed the three-dose monovalent series. Since December 2022, patients 6 months to 4 years who received the first two doses with the monovalent Pfizer-BioNTech COVID-19 vaccine should have completed their three-dose primary series with the bivalent third dose (0173A). Those patients are not eligible for a booster, the EUA states.

For More Information: https://www.aapc.com/blog/87568-new-covid-19-code-for-bivalent-booster/

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