August 19, 2021
The Centers for Disease Control and Prevention (CDC) officially recommended the administration of a third vaccine dose from Pfizer/BioNTech or Moderna for such individuals, including patients who have been receiving active cancer treatment for tumors or blood cancers, those who have received organ transplant or stem cell transplant, and those with moderate or severe primary immunodeficiency. America's Health Insurance Plans (AHIP) said health plans will continue to cover all vaccine administrative costs for their members as required, while Centers for Medicare & Medicaid Services (CMS) said Medicare will reimburse providers at the same rate for the booster shot as for the previous COVID-19 vaccine dose.
The third dose should be coded as follows. Correct coding is required to process your claim. Claims that are incorrectly coded may be rejected.
0003A – PFIZER Third Dose
(Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS[1]CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA[1]LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted (Effective 08/12/2021)
0013A – MODERNA Third Dose
(Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV[1]2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; (Effective 08/12/21)
These codes should be billed for the third dose of the Pfizer and Moderna vaccines. Only individuals that meet the requirements established by the FDA and CDC should receive the third dose.