COVID-19 Vaccine, Monoclonal Antibodies and Administration - JF Part A

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

• CDC COVID-19 Vaccination Communication Toolkit for medical centers, clinics, and clinicians
• CMS COVID-19 End of Public Health Emergency FAQs
• CMS COVID-19 FAQs (PDF):
• CMS COVID-19 Provider Toolkit
• CMS Monoclonal Antibody COVID-19 Infusion
• CMS Office of Minority Health COVID-19 Resources on Vulnerable Populations
• CMS Vaccine Pricing
• Healthcare System Cybersecurity: Readiness & Response Considerations
• FDA COVID-19 Vaccines
• PC-ACE Software