© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 91304 refers to a specific vaccine designed to provide immunity against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the disease known as coronavirus disease (COVID-19). This vaccine is classified as a recombinant spike protein nanoparticle vaccine, utilizing a saponin-based adjuvant to enhance the immune response. The dosage of this vaccine is 5 mcg per 0.5 mL, and it is intended for intramuscular administration. Unlike other types of COVID-19 vaccines, such as mRNA vaccines (e.g., Moderna and Pfizer) and viral vector vaccines (e.g., Johnson & Johnson and AstraZeneca), this vaccine does not contain any genetic material. Instead, it contains the spike protein of the coronavirus itself, which is produced outside the body using a baculovirus to infect moth cells. This process allows for the replication of the spike protein, which is then purified and combined with a saponin adjuvant derived from the soapbark tree. This adjuvant plays a crucial role in enhancing the immune response, enabling a smaller dose of the spike protein to effectively stimulate the immune system. Upon intramuscular injection, the vaccine prompts the immune system to generate antibodies and T-cell immunity against SARS-CoV-2, thereby providing protection against COVID-19. It is important to note that this code specifically reports the supply of the vaccine, while the administration of the injection is reported separately.
© Copyright 2025 Coding Ahead. All rights reserved.
The vaccine coded under CPT® 91304 is indicated for the prevention of coronavirus disease (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is specifically designed to provide immunity against the virus, thereby reducing the risk of severe illness, hospitalization, and death associated with COVID-19.
The administration of the vaccine coded as CPT® 91304 involves several key procedural steps that ensure the effective delivery of the vaccine to the patient.
Following the administration of the vaccine coded as CPT® 91304, patients may experience common side effects such as soreness at the injection site, mild fever, fatigue, or headache. These effects are generally mild and resolve within a few days. Patients should be advised to report any unusual or severe reactions to their healthcare provider. Additionally, it is important to inform patients about the need for follow-up doses if applicable, as well as the importance of continuing to follow public health guidelines to prevent the spread of COVID-19.
| Short Descr | SARSCOV2 VAC 5MCG/0.5ML IM | Medium Descr | SARSCOV2 VACC SAPONIN-BSD ADJT 5MCG/0.5ML IM USE | Long Descr | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use | Related Drugs | NOVAVAX COVID-19 Vaccine, Adjuvanted | Status Code | Statutory Exclusion (from MPFS, may be paid under other methodologies) | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 9 - Not Applicable | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Influenza, Pneumococcal Pneumonia, Hepatitis B, and Covid-19 Vaccines; Monoclonal Antibody Therapy Product | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | SL | State supplied vaccine |
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Date
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Action
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Notes
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| 2025-01-01 | Note | First appearance of guideline change to include 90480 in codebook. |
| 2023-09-11 | Note | AMA guideline changed. Codes 0041A, 0042A, 0044A have been deleted from the guideline and changed to 90480 effective upon 90480 receiving Emergency Use Authorization or approval from the FDA. |
| 2023-08-14 | Changed | Description changed. Preservative free removed from description and Guideline added. |
| 2023-04-18 | Note | AMA Guideline changed. 0144A received FDA approval. |
| 2023-01-01 | Note | First appearance of guideline change(s) in codebook. |
| 2022-10-10 | Note | Guidelines changed to include code 0044A. Effective upon receiving Emergency Use Authorization or approval from the FDA. |
| 2022-10-10 | Note | Changes made to include 12 years and older. |
| 2022-08-31 | Note | Changes made to vaccine patient age (18+). |
| 2022-07-13 | Added | FDA approval for 91304 received & published to website 2022-07-26. Effective retroactively to 2022-07-13. |
| 2022-07-13 | Note | AMA guideline changed. 0041A, 0042A received FDA approval. |
| 2022-01-01 | Added | First appearance in codebook |
| 2022-01-01 | Note | Grammar correction |
| 2022-01-01 | Changed | Code description changed. |
| 2021-05-04 | Added | Published on AMA website. Effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration. |
| 2021-05-04 | Note | AMA quideline codes 0041A, 0042A published to website. Effective upon receiving emergency Use Authorization or approval from the FDA. |
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