© Copyright 2025 American Medical Association. All rights reserved.
The CPT® Code 91321 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), with a dosage of 25 mcg per 0.25 mL intended for intramuscular administration. The mRNA component of the vaccine encodes for the spike protein of the SARS-CoV-2 virus, which is crucial for the virus's ability to infect human cells. By introducing this mRNA into the body, the vaccine prompts cells 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 neutralize the virus upon future exposure. The specific formulation referenced in this code is tailored for pediatric use, targeting children aged 6 months to 11 years. It is important to note that this code is used solely for reporting the supply of the vaccine and does not include the administration of the vaccine, which must be reported separately. The vaccine's formulation includes buffering agents that stabilize the product and maintain its pH, allowing it to be stored at standard refrigerator temperatures, thus ensuring its viability for use in the pediatric population.
© Copyright 2025 Coding Ahead. All rights reserved.
The COVID-19 vaccine coded as CPT® 91321 is indicated for the prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, which can lead to coronavirus disease (COVID-19). This vaccine is specifically designed for use in children aged 6 months through 11 years, providing protection against the potentially severe and life-threatening effects of the virus.
The administration of the COVID-19 vaccine involves several key procedural steps to ensure safety and efficacy. First, the healthcare provider must verify the patient's eligibility for vaccination, confirming that the individual falls within the appropriate age range and has no contraindications to receiving the vaccine. Next, the provider prepares the vaccine by gently shaking the vial to ensure proper suspension of the mRNA-LNP formulation. Following preparation, the provider selects an appropriate injection site, typically the deltoid muscle of the upper arm for older children or the anterolateral thigh for infants and younger children. The skin at the injection site is then cleaned with an antiseptic wipe to minimize the risk of infection. The vaccine is administered intramuscularly using a sterile syringe and needle, ensuring that the entire dose is delivered. After the injection, the provider may apply a bandage to the injection site and monitor the patient for a brief period to observe for any immediate adverse reactions. Documentation of the vaccine administration, including the date, vaccine lot number, and site of injection, is essential for maintaining accurate medical records.
After the administration of the COVID-19 vaccine, it is important to monitor the patient for any immediate adverse reactions, which may include mild side effects such as soreness at the injection site, fatigue, or low-grade fever. Patients are typically observed for a short period, usually around 15 minutes, to ensure that any potential allergic reactions can be promptly addressed. Following this observation period, patients can resume normal activities, although they may be advised to avoid strenuous exercise for a short time. It is also essential to provide caregivers with information regarding potential side effects and the importance of completing the vaccination series, if applicable. Documentation of the vaccine administration should be completed in the patient's medical record, including the date, vaccine lot number, and any observed reactions. Additionally, caregivers should be informed about the need for follow-up doses, if required, to ensure full vaccination coverage against COVID-19.
| Short Descr | SARSCOV2 VAC 25 MCG/.25ML IM | Medium Descr | SARSCOV2 VACCINE 25 MCG/0.25 ML FOR IM USE | Long Descr | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use | Related Drugs | Moderna 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 |
| 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. | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 |
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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 |
| 2023-08-14 | 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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