What’s new: CMS has issued Medicare billing guidance and vaccine pricing for the FDA-approved updated COVID-19 vaccines for the 2024–2025 season.

About the vaccines: 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. 

For billing:

• 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. 

Additional resources

• Visit the  CMS COVID-19 Vaccine Provider Toolkit for more information. Note: You may need to refresh your browser if you recently visited this webpage.
• Review AHCA/NCAL’s blogpost, Newly Approved COVID-19 Vaccines: What Long Term Care Providers Need to Know, which includes links to important clinical and consumer education resources.
• Go to #GetVaccinated for additional resources.