Billing Information for Updated COVID-19 Vaccines for 2024–2025 Season

COVID-19; vaccine; Infection Prevention/Control; GetVaccinated
 
Published:September 17, 2024
Dan Ciolek

Recently, AHCA/NCAL provided information about Newly Approved COVID-19 Vaccines: What Long Term Care Providers Need to Know, including links to important clinical and consumer education resources. 

This week, the Centers for Medicare and Medicaid Services (CMS) issued the following Medicare billing guidance regarding the FDA-approved updated COVID-19 vaccines for the 2024–2025 season: 


These vaccines target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death: 

  • The Pfizer-BioNTech and Moderna COVID-19 vaccines include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2. 
  • The Novavax COVID-19 Vaccine, Adjuvanted, includes a monovalent (single) component that corresponds to the Omicron variant JN.1 strain of SARS-CoV-2. 

CMS has updated COVID-19 vaccine pricing for the 2024–2025 season: 

  • CPT codes 91318–91322, effective August 22, 2024 (Note: no change to payment allowances from last season for 91318–91319) 
  • CPT code 91304, effective August 30, 2024 

Use CPT code 90480 to bill for the administration of the vaccine. 

Visit the COVID-19 Vaccine Provider Toolkit for more information. Note: You may need to refresh your browser if you recently visited this webpage. 

Visit #GetVaccinated​ for additional resources. 

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