© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 91312 refers to the bivalent mRNA-LNP vaccine designed to provide immunity against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for the disease known as COVID-19. This vaccine is formulated with messenger RNA (mRNA) that encodes the spike protein of the virus, allowing the immune system to recognize and respond to the virus effectively. The vaccine is preservative-free and is delivered in a dosage of 30 mcg per 0.3 mL, specifically designed for intramuscular administration. The bivalent nature of this vaccine means it contains mRNA components from both the original strain of the virus and the omicron variant, which includes the BA.4 and BA.5 subvariant lineages. This dual-target approach enhances the immune response and provides broader protection against circulating strains of the virus. The lipid nanoparticles (LNP) encapsulating the mRNA facilitate the delivery of the genetic material into the body's cells, enabling them to produce the viral spike protein without the need for additional adjuvants to stimulate the immune response. Following vaccination, the immune system generates antibodies that can recognize and neutralize the virus upon exposure, thereby reducing the risk of severe illness. It is important to note that this code specifically reports the supply of the Pfizer-BioNTech bivalent booster vaccine for individuals aged 12 years and older who have previously received COVID-19 vaccinations. The TRIS-sucrose formulation includes buffering agents that help stabilize the vaccine and maintain its pH, ensuring its efficacy and safety during storage and administration.
© Copyright 2025 Coding Ahead. All rights reserved.
The CPT® Code 91312 is indicated for the administration of the bivalent mRNA-LNP COVID-19 vaccine in individuals who meet the following criteria:
The procedure for administering the CPT® Code 91312 vaccine involves several key steps to ensure proper delivery and effectiveness:
Following the administration of the CPT® Code 91312 vaccine, patients are advised to remain in the healthcare setting for a brief observation period to monitor for any potential side effects or allergic reactions. Common post-vaccination reactions may include soreness at the injection site, fatigue, headache, muscle pain, chills, fever, or joint pain. Patients should be informed about these potential side effects and advised to report any severe or unusual symptoms to their healthcare provider. Additionally, individuals should be encouraged to continue following public health guidelines regarding COVID-19, including mask-wearing and social distancing, as appropriate, even after vaccination.
| Short Descr | 312 SARSCOV2 VAC BVL 30MCG/0.3ML | Medium Descr | SARSCOV2 VACCINE BIVALENT 30 MCG/0.3 ML IM USE | Long Descr | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, bivalent spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | 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 | Not applicable/unspecified. |
| CR | Catastrophe/disaster related | SL | State supplied vaccine | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 | 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. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | JZ | Zero drug amount discarded/not administered to any patient | KX | Requirements specified in the medical policy have been met | QW | Clia waived test | SA | Nurse practitioner rendering service in collaboration with a physician | SE | State and/or federally-funded programs/services | U6 | Medicaid level of care 6, as defined by each state | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care |
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| 2025-01-01 | Deleted | First appearance of code deletion in codebook. |
| 2025-01-01 | Deleted | First appearance of code deletion in codebook. |
| 2024-01-01 | Added | First appearance in Codebook. |
| 2023-11-01 | Deleted | Code deleted. See 91318, 91319, 91320, 91321, 91322. |
| 2023-04-18 | Note | These codes (included in the guidelines) are no longer authorized for use in the United States: 0001A, 0002A, 0003A, 0004A, 0051A, 0052A, 0053A, 0054A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A |
| 2023-04-18 | Note | AMA guideline changed to include 0151A, 0171A, & 0172A. Published to website 2023-05-01. Received FDA approval effective retroactively to 2023-04-18. |
| 2023-04-18 | Note | Changes made to dosing information. |
| 2023-03-14 | Note | AMA guideline changed to include 0174A. Published to website 2023-03-17. Received FDA approval effective retroactively to 2023-03-14. |
| 2022-12-08 | Note | AMA guideline changed to include 0173A. Published to website 2021-12-09. Received FDA approval effective retroactively to 2022-12-08. |
| 2022-08-31 | Added | Published on AMA website. 91312 FDA approval received effective immediately. |
| 2022-08-31 | Note | AMA guideline added to include 0124A, 0154A effective upon receiving emergency Use Authorization or approval from the FDA. |
| 2022-08-31 | Note | AMA Guideline changed. 0124A received FDA approval. |
| 2022-08-31 | Note | AMA guideline includes 0001A, 0002A, 0003A, 0004A, 0051A, 0052A, 0053A, 0054A, 0071A, 0072A, 0073A, 0074A, 0081A, 0082A, 0083A: Published on AMA website & received FDA approval prior to the addition of 91312. |
| 2022-08-31 | Note | Changes made to vaccine name, product & dosing information, & patient age (12+). |
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