COVID-19 Vaccine, Monoclonal Antibodies and Administration

HCPCS/CPT Codes

CMS has started the process of closing out the effective dates for certain COVID vaccines and monoclonal antibodies. Please see CMS COVID-19 Vaccines and Monoclonal Antibodies page for the most up-to-date list of these codes, including their effective date periods.

New CPT effective October 3, 2023:

  • 91304 - COVID-19 Vaccine, 5 mcg/0.5 mL
    • With CPT 90480 COVID-19 Vaccine Administration below
    • Beneficiary cost-sharing waived

New CPTs effective September 11, 2023:

  1. 90480 - COVID-19 Vaccine Administration
  2. 91318 - COVID-19 Vaccine, 3 mcg/0.2 mL
  3. 91319 - COVID-19 Vaccine, 10 mcg
  4. 91320 - COVID-19 Vaccine, 30 mcg
  5. 91321 - COVID-19 Vaccine, 25 mcg
  6. 91322 - COVID-19 Vaccine, 50 mcg

Coverage

  • All Medicare beneficiaries
  • Original Medicare no longer pays COVID-19 vaccine or monoclonal antibody product administration claims for Medicare Advantage beneficiaries on or after January 1, 2022, unless the beneficiary in a Medicare Advantage plan has chosen to enroll in hospice.

Payment

Copayment/coinsurance waived; Deductible waived

Pricing

For payment rates for COVID-19 vaccine administration, visit the COVID-19 Vaccine and Monoclonal Antibodies Pricing webpage on CMS.

Resources

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