How your Primary Practice should prepare for upcoming “Tripledemic” Vaccination Changes Implementation and Updates!
CDC's division National Center for Immunization and Respiratory Diseases (NCIRD) and USPHS captain discuss upcoming Flu and RSV cases.
After a summer of peace, it's time to gear up for the changes coming as this is the season of Vaccines and Tests. This year, the flu season might prove to be more concerning as this time COVID-19 might give it company.
Why is this season going to be hard?
- New and stronger variants are on the rise.
- Increased hospitalized cases.
- Weakened immunity in Peads and Geriatric communities.
- Timely and Easy Provision of Vaccinations.
- Now relaxed, not well-prepared population (and practices).
- COVID-19 activity makes it difficult to monitor the impact of influenza-reported stats.
There is no need to panic though, grab your favorite mug of hot cocoa and relax as we go through these updates!. This article covers efficient ordering, diagnosis, billing, & coding for tests, vaccines, and counseling. We will try to go through so you can master them before the said 'Tripledemic' hits.
Respiratory Syncytial Virus (RSV)
New CPT codes address RSV prevention innovations.
5 new CPT codes track product-specific RSV immunizations for data-driven planning.
Coronavirus SARS-CoV-2 Disease (COVID-19)
Key CPT changes for 2024: Consolidating 50+ codes for COVID-19 immunizations. CPT Panel approved codes (91318-91322) for Moderna and Pfizer COVID-19 vaccines. Provisional codes 91318-91322 for Moderna/Pfizer COVID vaccines. New admin code 90480 replaces previous product-specific codes. replacing all previously approved product-specific vaccine administration codes.
American Medical Association (AMA) scrapping most COVID vaccine CPT codes on Nov 1. In their place, you’ll have a shorter list of product codes and a single administration code. View current COVID-19 codes at a glance on our cheat sheet.
Over 70 COVID-19 vaccine codes deleted on Nov 1, 2023. In 2024, 50+ codes merge into 17 (91300-91317) + 90480 for COVID-19 vaccine admin. The latter replaces all previously approved specific vaccine administration codes.
New Immunization Administration for Vaccines/Toxoids Code:
2024: 50+ COVID-19 immunization codes consolidated, new vaccine admin codes, & 5 RSV immunization codes. The CPT Panel revises E/M service reporting for clarity.
New Pfizer Vaccine
Age Group: Children (6mo – 11y)
91318 – COVID-19 mRNA vaccine for intramuscular use.
Dosage: 3 mcg/0.2 mL dosage – (6mo - 4y)
91319 – SARS-CoV-2 mRNA vaccine with Tris-Sucrose formulation for intramuscular use.
Dosage: 10 mcg/0.3 mL dosage – (5y - 11y)
Age Group: 12y+ to Adults
91320 – SARS-CoV-2 mRNA vaccine with Tris-Sucrose for intramuscular use.
Dosage: 30 mcg/0.3 mL – (12y+)
New Moderna Vaccine
Age Group: Children (6mo – 11y)
91321 – COVID-19 mRNA vaccine for intramuscular use.
Dosage: 25 mcg/0.25 mL dosage – (6mo - 11y)
Age Group: 12y+ to adults.
91322 – COVID-19 mRNA vaccine for intramuscular use.
Dosage: 50 mcg/0.5 mL dosage – (12y+)
Revised Novavax Vaccine
Preservative free” has been removed from the code descriptor for the Novavax vaccine:
91304 – COVID-19 vaccine: spike nanoparticle with saponin adjuvant, 5 mcg/0.5 mL
- This code continues to be available for use
- Also, code 90480 in addition to Administration of this vaccine.
New Immunization Administration for Vaccines/Toxoids Code
90480 - COVID-19 vaccine, single dose, intramuscular injection
Note:
Remember: Counseling is included in code 90480 and should not be reported separately. Don’t forget to add Z23 as the associated diagnostic ICD-10 code.
Side-note: COVID-19 lab testing ordering requirements reconciled and revised.
Projected U.S. Flu Vaccine Supply for the 2023-2024 Season
CDC recommends flu vaccine for everyone 6 months and older by end of October for 2023-2024 season. Medicare Part B flu vaccine payment allowances have changed.
Influenza A and B
Flu A viruses have the most impact, causing serious illness and deaths. Type B infections are less common and usually milder than influenza A (H3N2).
Type B infections are less common and usually milder than influenza A (H3N2).
Vaccination is the most effective form of influenza prevention.
- Manufacturers plan to supply the US with 156.2-170 million flu vaccine doses for 2023-2024. These projections may change as the season progresses.
- All flu vaccines for the 2023-2024 season will be quadrivalent (four-component).
- 91% of flu vaccines will be thimerosal-free or thimerosal-reduced, with 21% being egg-free.
- Latest info on 2023-2024 flu vaccine distribution totals available. Part B deductible and coinsurance don't apply for flu shots.
- ICD-10-CM code Z23 for immunization and G0008 for flu vaccine on Medicare claims. Vaccine pricing updated on Aug. 1, while G0008 pricing effective Jan. 1 - Dec. 31.
What are Payment Allowances Changes expected this coming year?
Bottom-line:
During this challenging season for the immunocompromised or debilitated individuals. Vaccinations in primary care can prove to be a very crucial step in your practice. Clinicians should plan ahead for immunization eligibility and protocols in their practice! Though COVID-19 is now normal, timely vaccinations still require advance planning and management.
Gear up your Medical Practice for the Tripledemic challenges! Stay ahead with AltuMED's expert guidance on vaccination changes, new codes, and billing strategies. Partner with us for seamless coding and billing solutions. Schedule a call now!
Subscribe to Our Newsletter!
Subscribe to Our Newsletter!
Enter Your Email Address. We Promise We Won't Spam You