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Centers for Medicare and Medicaid Services (CMS) issued the following Medicare billing guidance regarding the FDA-approved updated COVID-19 vaccines for the 2024–2025 season:
- mRNA vaccines made by Pfizer-BioNTech and Moderna on August 22, 2024
- Novavax COVID-19 Vaccine, Adjuvanted on August 30, 20
These vaccines target currently circulating variants and provide better protection against serious consequences of COVID-19, including hospitalization and death:
- The Pfizer-BioNTech and Moderna COVID-19 vaccines include a monovalent (single) component that corresponds to the Omicron variant KP.2 strain of SARS-CoV-2.
- The Novavax COVID-19 Vaccine, Adjuvanted, includes a monovalent (single) component that corresponds to the Omicron variant JN.1 strain of SARS-CoV-2.
CMS has updated COVID-19 vaccine pricing for the 2024–2025 season:
- CPT codes 91318–91322, effective August 22, 2024 (Note: no change to payment allowances from last season for 91318–91319)
- CPT code 91304, effective August 30, 2024
Use CPT code 90480 to bill for the administration of the vaccine.
Visit the COVID-19 Vaccine Provider Toolkit for more information.