Summary & Overview
CPT 91304: SARS–CoV–2 Vaccine, 5 mcg/0.5 mL Intramuscular
CPT code 91304 denotes a SARS–CoV–2 vaccine product supplied for intramuscular injection at a dosage of 5 mcg/0.5 mL to prevent COVID–19. This code identifies the vaccine product itself and is used on claims to document administration of a specific COVID–19 vaccine formulation. Nationally, accurate coding for COVID–19 vaccines remains important for public health tracking, coverage determinations, and claims processing.
Key payers included in the coverage review are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise information on the clinical context of the vaccine, the typical settings where the vaccine is administered, and the administrative elements relevant to billing this product. The publication provides benchmarks and policy-relevant updates where available and flags areas where input data were not provided.
This summary equips billing professionals, revenue cycle staff, and clinical leaders with the essential description of CPT code 91304, guidance on expected use cases, and an outline of the payer landscape addressed in the analysis. Data not available in the input will be noted in the relevant sections.
Billing Code Overview
CPT code 91304 represents a SARS–CoV–2 vaccine product administered by intramuscular injection to prevent COVID–19. The listed dosage is 5 mcg/0.5 mL and the service is a vaccine administration intended for active immunization against SARS–CoV–2.
Service Type: Vaccine administration (preventive immunization)
Typical Site of Service: Outpatient clinics, physician offices, pharmacies, public health clinics, and other ambulatory care settings where intramuscular vaccinations are provided.
Clinical & Coding Specifications
Clinical Context
A typical adult patient presents to an outpatient clinic or pharmacy-based immunization site for routine COVID-19 vaccination with the SARS–CoV–2 vaccine product denoted by 91304 (5 mcg/0.5 mL, intramuscular). The patient arrives for either a primary immunization series dose or a booster dose based on current public health guidance and their prior immunization history. Registration staff verify identity, insurance, and contraindications (allergies, current febrile illness, history of severe reactions to prior COVID-19 vaccines). A licensed clinician (e.g., family medicine physician, nurse practitioner, registered nurse, or pharmacist) reviews consent, documents indications and any contraindications, and administers the intramuscular injection (typically deltoid muscle). Post–vaccine observation (15–30 minutes) is performed, and administration details (vaccine lot number, expiration date, site, route) are documented in the medical record and immunization registry. Billing is submitted using 91304 for the vaccine product and an appropriate administration code for intramuscular injection when applicable. Typical sites of service include outpatient physician offices, community pharmacies, public health clinics, and mass vaccination sites.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier / not commonly used by carriers |