Special Bulletin: AMA unveils new codes as COVID vaccine approval looms

Federal approval of the Pfizer vaccine, believed to be better than 90 percent effective, could occur before the end of the month.

When the long-awaited and much-anticipated COVID-19 vaccine becomes available in the U.S., a development that could take place before the end of the year, a set of new Current Procedural Terminology (CPT®) codes for documenting it will be ready and waiting, the American Medical Association (AMA) announced this week.

“These CPT codes are unique for each of two coronavirus vaccines, as well as administration codes unique to each such vaccine,” the AMA said in a writeup published on its website. “The new CPT codes clinically distinguish each coronavirus vaccine for better tracking, reporting, and analysis that supports data-driven planning and allocation.”

The announcement also cited an additional new code created “to describe the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency (PHE).”

The announcement coincided with the recent news that the pharmaceutical giant Pfizer’s vaccine candidate was found to be more than 90 percent effective, surpassing expectations. The company reportedly could receive emergency authorization for the vaccine from the Food and Drug Administration before the end of the month, meaning millions of Americans could receive it before 2021 begins – to be followed by tens of millions more throughout next year.

“But Pfizer – like other manufacturers that may soon be authorized to roll out their vaccines – does not fully control its own destiny,” the New York Times reported this week. “The effort will hinge on a collaboration among a network of companies, federal and state agencies, and on-the-ground health workers in the midst of a pandemic that is spreading faster than ever through the United States.”

Along with the announcement, AMA also listed descriptions of the new COVID-centric codes already in use, since the advent of the global pandemic earlier this year:

• Accepted addition of code 87635 to report infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique. The new code was effective March 13, 2020.
• Accepted revision of code 86318 to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328; addition of code 86328 to report single step antibody testing for severe acute respiratory syndrome coronavirus 2; addition of child code 86769 to report multiple-step antibody testing for severe acute respiratory syndrome coronavirus 2; and revision of the Immunology guidelines. The new codes and revision were effective April 10, 2020.
• Accepted addition of PLA code 0202U to report the BioFire® Respiratory Panel 2.1 (RP2.1) test. The new code was effective May 20, 2020.
• Accepted addition of code 87426 to report infectious agent antigen detection by immunoassay technique of SARS-CoV and SARS-CoV-2. In addition, two new PLA codes (0223U and 0224U) were accepted for detection of SARS-CoV-2.
• Accepted addition of codes 86408 for reporting coronavirus 2 (SARS-CoV-2) neutralizing antibody screen and 86409 for reporting coronavirus 2 (SARS-CoV-2) neutralizing antibody titer. In addition, two new PLA codes (0225U and 0226U) were accepted for detection of SARS-CoV-2. These new codes are effective Aug. 10, 2020.
• Accepted addition of code 99072 for the additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency, as defined by law. In addition, one code, 86413, was created for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
• Accepted addition of code 87636 for reporting combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B, code 87637 for combined respiratory virus multiplex testing for either SARS-CoV-2 with Influenza A&B and RSV and 87811for antigen detection of SARS-CoV-2 by direct optical (i.e., visual) observation.  Two new PLA codes (0240U and 0241U) were accepted for detection of SARS-CoV-2, Influenza A and Influenza B; code 0241U also detects RSV. Additionally, Immunology guidelines were also revised, along with codes 87301, 87802 and their subsidiary codes.
• Accepted addition of code 87428 for reporting multiplex viral pathogen panel using antigen immunoassay technique for SARS-CoV-2 testing along with influenza A and influenza B.
• Accepted addition of codes 91300, 91301 to report Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccines and codes 0001A, 0002A, 0011A, 0012A to report the immunization administration of these vaccines.

For more information, and to access an Excel file the AMA says it will update as new codes enter use, go online to https://www.ama-assn.org/practice-management/cpt/covid-19-cpt-coding-and-guidance.

The global COVID-19 pandemic has sickened more than 53 million people worldwide, killing an estimated 1.3 million. The United States accounts for nearly 11 million cases and 250,000 deaths alone. A recent nationwide spike in new cases has seen daily totals climb from highs of 75,000 during an initial spike this summer double to more than 150,000 in recent days.