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COVID-19 VACCINES GUIDELINES<br />
COVID 19 VACCINE AGES TYPE OF CODE CPT ECW CPT NAME<br />
EFFECTIVE<br />
J&J<br />
(JANSSEN)<br />
18 & OLDER<br />
VACCINE<br />
1ST DOSE ADMIN<br />
91303<br />
0031A<br />
COVID 19 (JANSSEN) >18YRS<br />
COVID-19 IM ADMIN (J&J) BOOSTER<br />
COMPONENT<br />
2/27/2021<br />
VACCINE<br />
91301<br />
COVID 19 (MODERNA) >18YRS<br />
MODERNA<br />
18 & OLDER<br />
1ST DOSE ADMIN<br />
2ND DOSE ADMIN<br />
3RD DOSE ADMIN<br />
BOOSTER VACCINE<br />
BOOSTER ADMIN<br />
0011A<br />
0012A<br />
0013A<br />
91306<br />
0064A<br />
COVID-19 IM ADMIN (MODERNA) 1ST<br />
COMPONENT<br />
COVID-19 IM ADMIN (MODERNA) 2ND<br />
COMPONENT<br />
COVID-19 IM ADMIN (MODERNA) 3RD<br />
COMPONENT<br />
BOOSTER-COVID 19 (MODERNA-0.25ML)<br />
>18YRS *7990<br />
COVID-19 IM ADMIN (0.25 ML MODERNA)<br />
BOOSTER COMPONENT<br />
12/18/2020<br />
10/20/2021<br />
VACCINE<br />
91300<br />
COVID-19 (PFIZER) >12YRS<br />
PURPLE<br />
1ST DOSE ADMIN<br />
2ND DOSE ADMIN<br />
3RD DOSE ADMIN<br />
0001A<br />
0002A<br />
0003A<br />
COVID-19 IM ADMIN (PFIZER) 1ST<br />
COMPONENT<br />
COVID-19 IM ADMIN (PFIZER) 2ND<br />
COMPONENT<br />
COVID-19 IM ADMIN (PFIZER) 3RD<br />
COMPONENT<br />
8/12/2021<br />
10/20/2021<br />
PFIZER<br />
12 & OLDER<br />
BOOSTER ADMIN 0004A COVID-19 IM ADMIN (PFIZER) BOOSTER 9/22/2021<br />
VACCINE 91305 COVID 19 (PFIZER- GRAY) >12YRS<br />
GRAY<br />
1ST DOSE ADMIN<br />
2ND DOSE ADMIN<br />
3RD DOSE ADMIN<br />
BOOSTER ADMIN<br />
0051A<br />
0052A<br />
0053A<br />
0054A<br />
COVID-19 IM ADMIN (PFIZER-GRAY) 1ST<br />
DOSE<br />
COVID-19 IM ADMIN (PFIZER-GRAY) 2ND<br />
DOSE<br />
COVID-19 IM ADMIN (PFIZER-GRAY) 3RD<br />
DOSE- IMMUNO<br />
COVID-19 IM ADMIN (PFIZER-GRAY)<br />
BOOSTER<br />
1/3/<strong>2022</strong><br />
PFIZER<br />
PEDIATRICS<br />
ORANGE<br />
*Effective 03/28/<strong>2022</strong><br />
CHILDREN<br />
5-11<br />
VACCINE<br />
1ST DOSE ADMIN<br />
2ND DOSE ADMIN<br />
91307<br />
0071A<br />
0072A<br />
Self-Pay/Underinsured Patients: Vaccine administration will be FREE. Per the Centers for Disease Control and Prevention’s<br />
Requirements for COVID-19 Vaccination Program Providers, providers must continue to administer COVID-19 vaccines at no<br />
out-of-pocket cost to recipients.<br />
Process for COVID Vaccines:<br />
Document in ECW (as any other service) by creating a progress note.<br />
Create a claim<br />
Adjust the claim using TERMCVD adjustment code.<br />
<br />
<br />
COVID 19 (PFIZER) PEDIATRIC 5-11YRS<br />
COVID-19 IM ADMIN CHILD - (PFIZER) 1ST<br />
COMPONENT<br />
COVID-19 IM ADMIN CHILD - (PFIZER) 2ND<br />
COMPONENT<br />
<br />
10/29/2021<br />
*Updates found in green font.
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