Are you a dental professional administering COVID-19 vaccines?

8 New Codes Added to CDT 2021, effective now

The ADA Code Maintenance Committee approved the following 8 new codes to be included in CDT 2021. These codes were accepted into CDT 2021 under special provision during the annual CMC meeting held on March 11-12, 2021. These codes have been added to CDT 2021 in response to the current pandemic. Currently, at least 25 states have approved dentists and 14 states have approved dental hygienists to administer the SARS-CoV-2 COVID-19 vaccines. 

The following 7 new codes document COVID-19 vaccine administration. These codes are listed in the preventive category of CDT. The CDT code language was developed based on direction given by operation WARP speed to ensure quality reporting for tracking purposes. It is critical that all healthcare providers are given the necessary tools for accurate monitoring.  

D1701 Pfizer-BioNTech Covid-19 vaccine administration – first dose

SARSCOV2 COVID-19 VAC mRNA 30mcg/0.3mL IM DOSE 1

D1702 Pfizer-BioNTech Covid-19 vaccine administration – second dose

SARSCOV2 COVID-19 VAC mRNA 30mcg/0.3mL IM DOSE 2

D1703 Moderna Covid-19 vaccine administration – first dose

SARSCOV2 COVID-19 VAC mRNA 100mcg/0.5mL IM DOSE 1

D1704 Moderna Covid-19 vaccine administration – second dose

SARSCOV2 COVID-19 VAC mRNA 100mcg/0.5mL IM DOSE 2

D1705 AstraZeneca Covid-19 vaccine administration – first dose

SARSCOV2 COVID-19 VAC rS-ChAdOx1 5×1010 VP/.5mL IM DOSE 1

D1706 AstraZeneca Covid-19 vaccine administration – second dose

SARSCOV2 COVID-19 VAC rS-ChAdOx1 5×1010 VP/.5mL IM DOSE 2

D1707 Janssen Covid-19 vaccine administration

SARSCOV2 COVID-19 VAC Ad26 5×1010 VP/.5mL IM SINGLE DOSEThese CDT vaccine codes give dentists administering COVID-19 vaccines in their private practice and those administering in a public health setting, a code to document and report into state and national vaccination tracking systems. Additionally, these new CDT codes will enable accurate documentation in the patient record and for billing purposes. 

Any healthcare provider, including dentists and hygienists agree to report vaccine administration to their state, which then will feed the information into the national vaccine tracking system for surveillance. These new CDT codes satisfy the need for accurate reporting, as required. 

For additional CDT coding guidance from the ADA, refer to the ADA Guide to CDT’s “COVID-19” Vaccination Procedure Codes. This Guide may be found at http://www.ada.org/~/media/ADA/Publications/Files/CDT_COVID_19_VaccinationProcedureCodeGuidance_2021Mar.pdf. 

Reimbursement

During a public health emergency, known as PHE, anyone in the United States is eligible to receive a COVID-19 vaccine at no charge. The latest and fourth extension of the PHE is April 20, 2021. For the uninsured, the healthcare provider may file a claim with the provider relief fund for reimbursement of the administration only. The vaccine product itself is currently provided to the dentist or healthcare facility at no charge. 

Vaccine administration of any type is considered medical in nature. For commercial or employer sponsored plans, the claim should be submitted to the patient’s medical plan as the primary plan. Current Procedural Terminology (CPT) codes should be applied to the medical claim. 

Commercial dental payers do not currently have the programming in place to process and track these new procedure codes. It can take months to have necessary programming updates in place. However, state Medicaid plans do have a system in place for tracking purposes as these plans have a direct connection to Centers for Medicare and Medicaid Services (CMS) for tracking purposes. 

Some state Medicaid programs are providing reimbursement for these vaccine administration services. This is state specific and you should refer to your state for guidance before submitting a claim. 

Centers for Medicare and Medicaid Services (CMS) has released a toolkit specifically related to testing and vaccine administration for COVID-19. This toolkit includes various information including reimbursement rates for Original Medicare and Medicare Advantage plans. You are encouraged to visit https://www.cms.gov/covidvax for the most up to date information available. 

How do I submit to medical?

When submitting any procedure that is medical in nature to Medicaid, submit the CDT code using the current ADA dental claim form. When submitting vaccine administration to commercial payers, a CPT and ICD-10-CM code applied to the current medical claim form is required. 

The following CPT codes are available for reporting the administration of COVID-19 vaccines. As with the CDT codes, each code is specific to the vaccine product administered.

0001A & 0002A  Pfizer-BioNTech Covid-19 vaccine administration

0011A & 0012A  Moderna Covid-19 vaccine administration

0021A & 0022A AstraZeneca Covid-19 vaccine administration

00312A Janssen Covid-19 vaccine administration

The AMA has published a great COVID-19 vaccine coding tool and is available at https://www.ama-assn.org/find-covid-19-vaccine-codes#. This may be especially useful as new vaccine products become available. 

Additionally, you might find this resource useful https://www.immunize.org/.

Cross Coding

The following chart illustrates how to accurately cross code the CDT code to CPT.

All medical claims require at least one diagnosis code. The following generic vaccine administrationICD-10-CM code is appropriate when  reporting COVID-19 vaccine administration. The CPT code identifies the specificity of the product used and the disease. 

Z23 Encounter for immunization

CDT code for molecular COVID-19 testing – the 8th new code added to CDT 2021

The following new code documents molecular testing for molecular testing of public health related pathogens, including coronavirus. 

D0606 molecular testing for a public health related pathogen, including coronavirus

Code D0606 closes a gap in the section of CDT for testing for public health related pathogens and is effective immediately. D0606 reports a rapid COVID-19 test. Molecular tests have been proven to be accurate and are available to dentists to perform in office. 

It is important to note that the practice providing molecular testing in the office may be subject to CLIA rules. For additional information regarding CLIA, visit https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA 

Disclosure and Resources

The information provided in this article is current as of the publication date. The CMC is dedicated to consider inclusion of additional pandemic related procedures as needed throughout the pandemic. It is advisable to stay up to date with any local, state and federal rules and regulations by utilizing the resources referenced in this article.