© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 91320 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 specified is 30 mcg in a volume of 0.3 mL, and it is intended for intramuscular administration. The vaccine targets the spike protein of the SARS-CoV-2 virus, which is a critical component that the virus uses to enter human cells. By introducing the mRNA that encodes this spike protein, the vaccine prompts the body’s cells to produce the spike protein, thereby training the immune system to recognize and respond to the actual virus if encountered in the future. This particular formulation is a monovalent vaccine, meaning it is designed to provide immunity against a single variant of the virus, specifically the XBB.1.5 Omicron variant. The tris-sucrose formulation included in this vaccine serves to stabilize the mRNA and maintain its efficacy during storage, allowing it to be kept at standard refrigerator temperatures. It is important to note that while this code reports the supply of the vaccine, the actual administration of the vaccine is billed separately.
© Copyright 2025 Coding Ahead. All rights reserved.
The COVID-19 vaccine represented by CPT® Code 91320 is indicated for the prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which can lead to coronavirus disease (COVID-19). The vaccine is specifically designed for use in adults and children aged 12 years and older, providing protection against the potentially severe and life-threatening effects of the disease caused by the virus.
The administration of the COVID-19 vaccine involves several key procedural steps to ensure proper delivery and effectiveness. Each step is critical to the overall success of the vaccination process.
Following the administration of the COVID-19 vaccine, patients may experience common side effects, which can include pain at the injection site, fatigue, headache, muscle pain, chills, fever, and nausea. These side effects are generally mild to moderate and resolve within a few days. Patients are advised to rest and stay hydrated. It is also important for patients to be informed about the need for follow-up doses if applicable, as well as the importance of continuing to follow public health guidelines regarding COVID-19, even after vaccination. Documentation of the vaccination should be completed in the patient's medical record, including the date of administration, vaccine lot number, and the site of injection.
| Short Descr | SARSCV2 VAC 30MCG TRS-SUC IM | Medium Descr | SARSCOV2 VACC 30MCG/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, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use | Related Drugs | Comirnaty | 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 | SL | State supplied vaccine | JZ | Zero drug amount discarded/not administered to any patient | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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. | LT | Left side (used to identify procedures performed on the left side of the body) | RT | Right side (used to identify procedures performed on the right side of the body) | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | 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 | 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) | CG | Policy criteria applied | CR | Catastrophe/disaster related | GT | Via interactive audio and video telecommunication systems | GZ | Item or service expected to be denied as not reasonable and necessary | HA | Child/adolescent program | HX | Funded by county/local agency | JG | Drug or biological acquired with 340b drug pricing program discount, reported for informational purposes | K1 | Lower extremity prosthesis functional level 1 - has the ability or potential to use a prosthesis for transfers or ambulation on level surfaces at fixed cadence. typical of the limited and unlimited household ambulator. | KX | Requirements specified in the medical policy have been met | PA | Surgical or other invasive procedure on wrong body part | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | 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) | QW | Clia waived test | SA | Nurse practitioner rendering service in collaboration with a physician | SK | Member of high risk population (use only with codes for immunization) | TF | Intermediate level of care | U8 | Medicaid level of care 8, as defined by each state | UC | Medicaid level of care 12, as defined by each state | UD | Medicaid level of care 13, as defined by each state | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2025-01-01 | Added | First appearance of code and guideline in codebook |
| 2023-09-11 | Added | FDA Approval Received. |
| 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. |
Get instant expert-level medical coding assistance.