© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 91319 refers to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, specifically designed to combat coronavirus disease (COVID-19). This vaccine utilizes a formulation of messenger RNA (mRNA) encapsulated in lipid nanoparticles (LNP), which is a method that allows the mRNA to be effectively delivered into human cells. The dosage of this vaccine is 10 mcg per 0.3 mL, and it is intended for intramuscular use. The mRNA contained in the vaccine corresponds to the spike protein of the coronavirus, which is a critical component that the virus uses to enter human cells. Upon administration, the cells utilize the mRNA as a template to produce the spike protein, which is then recognized by the immune system as a foreign entity. This recognition triggers an immune response, leading to the production of antibodies that can protect the individual from future infections with the virus. This specific vaccine formulation is a monovalent component that targets the XBB.1.5 Omicron variant of the virus, making it particularly relevant for current strains. The vaccine is designed for pediatric use, specifically for children aged 5 to 11 years, and is reported as a supply code, meaning it covers the vaccine itself but does not include the administration of the vaccine, which is billed separately. The tris-sucrose formulation is noteworthy as it includes buffering agents that help stabilize the vaccine, maintaining its pH balance and allowing for storage at standard refrigerator temperatures, which is essential for ensuring the vaccine's efficacy and safety prior to administration.
© Copyright 2025 Coding Ahead. All rights reserved.
The CPT® Code 91319 is indicated for the vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19). The vaccine is specifically designed for use in children aged 5 to 11 years, providing protection against the potentially severe and life-threatening effects of COVID-19. The vaccine is particularly relevant for addressing the XBB.1.5 Omicron variant of the virus, which has been a significant strain in circulation.
The administration of the vaccine coded by CPT® 91319 involves several key procedural steps to ensure proper delivery and effectiveness. First, the healthcare provider prepares the vaccine by retrieving it from refrigeration, ensuring that it is at the appropriate temperature for administration. The vaccine is then visually inspected for any particulates or discoloration, which would indicate that it should not be used. Next, the provider selects an appropriate injection site, typically the deltoid muscle of the upper arm for intramuscular administration. The skin at the injection site is cleaned with an antiseptic wipe to reduce the risk of infection. Following this, the provider draws the vaccine into a syringe, ensuring that the correct dosage of 10 mcg in 0.3 mL is administered. Once the vaccine is drawn, the provider inserts the needle into the muscle at a 90-degree angle and injects the vaccine slowly and steadily. After the injection, the needle is withdrawn, and gentle pressure is applied to the injection site with a cotton ball or gauze to minimize bleeding. Finally, the provider may apply a bandage to the site if necessary and documents the administration in the patient's medical record, including the vaccine lot number and expiration date for tracking purposes.
After the administration of the vaccine coded by CPT® 91319, patients are typically monitored for a short period to observe for any immediate adverse reactions, such as allergic responses. It is standard practice to keep the patient under observation for at least 15 minutes post-injection, especially in pediatric populations, to ensure their safety. Patients and guardians are advised about potential side effects, which may include soreness at the injection site, fatigue, headache, muscle pain, chills, fever, and joint pain. These side effects are generally mild and resolve within a few days. Additionally, caregivers are instructed on the importance of completing the vaccination series as recommended, including any follow-up doses if applicable. They are also provided with information on how to report any adverse events following vaccination and the importance of keeping vaccination records updated for future healthcare needs.
| Short Descr | SARSCV2 VAC 10MCG TRS-SUC IM | Medium Descr | SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE | Long Descr | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | Related Drugs | Pfizer-BioNTech Covid-19 Vaccine | 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 |
| GW | Service not related to the hospice patient's terminal condition | 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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Notes
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| 2025-01-01 | Added | First appearance of code and guideline in codebook |
| 2023-09-11 | Added | FDA Approval received |
| 2023-09-11 | Note | AMA Guideline changed. 0134A received FDA approval |
| 2023-09-08 | Note | Technical correction. |
| 2023-08-14 | Added | Code added, effective upon receiving Emergency Use Authorization or approval from the Food and Drug Administration |
| 2023-08-14 | Note | AMA guideline code 90480 published to AMA website. Effective upon receiving emergency Use Authorization or approval from the FDA. |
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