© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 91313 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 utilizes a bivalent formulation, meaning it contains messenger RNA (mRNA) components that correspond to both the original strain of the virus and a variant strain associated with the omicron variant, specifically targeting the BA.4 and BA.5 subvariant lineages. The vaccine is preservative-free and is administered in a dosage of 50 mcg per 0.5 mL via intramuscular injection. The mechanism of action involves the use of lipid nanoparticles (LNP) to encapsulate the mRNA, allowing it to be delivered effectively into the body's cells. Once inside, the cells utilize the mRNA as a template to produce the spike protein found on the surface of the coronavirus. This process triggers an immune response, prompting the body to generate antibodies that can recognize and combat the virus if the individual is exposed in the future. The vaccine is intended for individuals aged 18 years and older who have previously received COVID-19 vaccinations, serving as a booster to enhance their immune protection. It is important to note that while this code reports the supply of the vaccine, the actual administration of the vaccine is documented separately using the appropriate administration code.
© Copyright 2025 Coding Ahead. All rights reserved.
The CPT® Code 91313 is indicated for the administration of the bivalent COVID-19 vaccine to provide enhanced protection against the SARS-CoV-2 virus and the associated disease, COVID-19. This vaccine is specifically recommended for individuals who meet the following criteria:
The procedure for administering the CPT® Code 91313 vaccine involves several key steps to ensure proper delivery and effectiveness of the vaccine:
Following the administration of the CPT® Code 91313 vaccine, patients are advised to monitor for any side effects, which may include soreness at the injection site, fatigue, headache, muscle pain, chills, fever, or nausea. These side effects are generally mild and resolve within a few days. Patients should be informed about the importance of completing the vaccination series and encouraged to report any unusual or severe reactions to their healthcare provider. Additionally, individuals should continue to follow public health guidelines regarding COVID-19, including mask-wearing and social distancing, as appropriate, even after vaccination.
| Short Descr | SARSCOV2 VAC BVL 50MCG/0.5ML | Medium Descr | SARSCOV2 VACCINE BIVALENT 50 MCG/0.5 ML IM USE | Long Descr | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, bivalent, preservative free, 50 mcg/0.5 mL dosage, 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. |
| SL | State supplied vaccine | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | CR | Catastrophe/disaster related | 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. | GW | Service not related to the hospice patient's terminal condition | 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 | GZ | Item or service expected to be denied as not reasonable and necessary | KX | Requirements specified in the medical policy have been met | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | QJ | Services/items provided to a prisoner or patient in state or local custody, however the state or local government, as applicable, meets the requirements in 42 cfr 411.4 (b) | SE | State and/or federally-funded programs/services | SK | Member of high risk population (use only with codes for immunization) | U6 | Medicaid level of care 6, as defined by each state |
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Date
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Action
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Notes
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| 2025-01-01 | Deleted | First appearance of code deletion in codebook. |
| 2024-04-18 | Note | First appearance of guideline changes 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: 0011A, 0012A, 0013A, 0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A. |
| 2023-04-18 | Note | AMA guidelines changed to include 0141A, 0142A. Published to website 2023-05-01. Received FDA approval effective retroactively to 2023-04-18. |
| 2023-04-18 | Note | Change made to dosing information |
| 2023-01-01 | Added | First appearance in Codebook. |
| 2022-12-08 | Note | AMA Guideline changed. 0164A received FDA approval. |
| 2022-11-16 | Note | AMA guideline changed to include 0164A effective upon receiving Emergency Use Authorization or approval from the FDA |
| 2022-10-12 | Added | 91313 (12-17 yrs) Received FDA approval. |
| 2022-10-12 | Note | AMA Guideline changed. 0134A (12–17 yrs) & 0144A received FDA approval. |
| 2022-10-10 | Note | Code 91313 (12-17 yrs) is awaiting Emergency Use Authorization or approval from the FDA. |
| 2022-08-31 | Added | Code 91313 (18 yrs and older) Published on AMA website. FDA approval received effectively immediately. |
| 2022-08-31 | Note | AMA guideline codes 0011A, 0012A, 0013A, 0064A, 0091A, 0092A, 0093A, 0094A, 0111A, 0112A, 0113A published to website & received FDA approval prior to the addition of 91313. |
| 2022-08-31 | Note | AMA guideline codes 0144A published to website. Effective upon receiving emergency Use Authorization or approval from the FDA. |
| 2022-08-31 | Note | AMA Guideline changed. 0134A(18 yrs and older) received FDA approval effective immediately. |
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