CPT 91318 SARS–CoV–2 Vaccine Reimbursement | OpenPayer

Summary & Overview

CPT 91318: SARS–CoV–2 Vaccine (tris–sucrose), 3 mcg/0.3 mL

Headline: New CPT code 91318 captures a tris–sucrose SARS–CoV–2 vaccine formulation for intramuscular use

Lead: CPT code 91318 designates a SARS–CoV–2 vaccine product (tris–sucrose formulation) delivered intramuscularly at a dose of 3 mcg/0.3 mL to reduce the patient’s risk of COVID–19. This vaccine code is important for national vaccination reporting, inventory tracking, and payer reimbursement workflows.

What the code represents and why it matters: CPT code 91318 identifies a specific COVID–19 vaccine product and enables standardized billing and clinical documentation for administration events. Accurate use of this CPT code supports public health monitoring, claims processing, and supply-chain management during ongoing vaccination efforts.

Key payers covered: Analysis and coverage considerations typically involve major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: Readers will find clinical context for the vaccine formulation and administration route, payer coverage scope across major national insurers, and operational implications for sites of service. The publication includes benchmarks and coding guidance where available, summaries of policy updates relevant to COVID–19 vaccine codes, and considerations for claim submission and billing workflows.

Data availability: Data not available in the input for associated taxonomies, ICD-10 diagnoses, related codes, and service line.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 91318COVID-19 vaccineSARS-CoV-2vaccine administrationintramuscular injectionimmunization codingvaccine producttris-sucrose formulation

Billing Code Overview

CPT code 91318 represents a SARS–CoV–2 vaccine product (tris–sucrose formulation) administered by intramuscular injection to reduce the patient’s risk of contracting COVID–19. The dosage for this vaccine product is 3 mcg/0.3 mL.

Service Type: Vaccine administration (intramuscular)

Typical Site of Service: Outpatient clinics, primary care offices, pharmacies, mass vaccination sites, and other ambulatory care settings.

Clinical & Coding Specifications

Clinical Context

A 34-year-old relatively healthy adult presents to a primary care clinic for routine immunization. The clinician confirms vaccination history and documents informed consent. The patient receives the SARS–CoV–2 vaccine (tris–sucrose formulation) by intramuscular injection, 3 mcg/0.3 mL, in the deltoid. Post-vaccination, the patient is observed for 15 minutes for immediate adverse events. The clinician documents vaccine lot number, expiration, administration site, dose, route, and patient education on expected local and systemic reactions. Billing staff assign the vaccine product code 91318 and attach any applicable modifier(s) based on payer and clinical circumstance.

Coding Specifications

Modifier	Description	When to Use
`00`	(No modifier) Standard reporting when no special circumstances apply.	Use when vaccine is administered without extraordinary circumstances or additional reporting requirements.
`33`	Preventive service

CPT 91323: mRNA COVID-19 Vaccine, 10 mcg/0.2 mL Intramuscular

CPT-91322-SARS-COV-2-VACCINE-50MCG-INTRAMUSCULAR

CPT 91322: SARS–CoV–2 Vaccine, 50 mcg/0.5 mL Intramuscular

CPT-91299-UNLISTED-GASTROINTESTINAL-DIAGNOSTIC-PROCEDURE

CPT 91299: Unlisted Gastrointestinal Diagnostic Procedure

CPT-91320-SARS-COV-2-VACCINE-30MCG-INTRAMUSCULAR

CPT 91320: SARS–CoV–2 Vaccine (30 mcg/0.3 mL) Intramuscular

CPT-91200-LIVER-ELASTOGRAPHY-LESION-CHARACTERIZATION

CPT 91200: Liver Elastography for Lesion Characterization

CPT-91319-SARS-COV-2-VACCINE-TRIS-SUCROSE-10MCG-0-3ML-IM

CPT 91319: SARS–CoV–2 Vaccine (tris–sucrose), 10 mcg/0.3 mL IM

CPT-91321-SARS-COV-2-VACCINE-25MCG-IM-INJECTION

CPT 91321: SARS–CoV–2 Vaccine, 25 mcg Intramuscular Injection

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly administer routine vaccinations.
`207R00000X`	Internal Medicine	Adult medicine providers frequently provide COVID-19 vaccinations.
`363A00000X`	Nurse Practitioner	NPs commonly administer vaccines in ambulatory settings.
`363L00000X`	Physician Assistant	PAs frequently provide immunization services in clinics.
`364S00000X`	Registered Nurse	RNs often perform vaccine administration and documentation.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary and most common diagnosis code used to report administration of the COVID-19 vaccine.
`U07.1`	COVID-19, virus identified	Indicates active COVID-19 infection; generally not used when administering routine vaccine but relevant in clinical context.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when vaccination occurs during a routine health maintenance visit for pediatric patients; less common for adult dosing.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Used when vaccine is given during an adult preventive visit.
`Z51.89`	Encounter for other specified aftercare	May be used when vaccine administration is part of follow-up care or complex immunization schedule management.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90460`	Immunization administration through 18 years of age via any route, with counseling by physician or other qualified health care professional; first vaccine/toxoid component, per day	Used when counseling and administration are reported together for pediatric patients (not typical for `91318` adult dosing).
`90461`	Each additional vaccine/toxoid component administered (same date)	Used to report additional vaccine components administered on the same day.
`90471`	Immunization administration (single vaccine) for intramuscular injection	Commonly used to report the administration service for an adult vaccine like `91318` when separate administration code is required.
`90472`	Each additional vaccine administration (intramuscular)	Use when multiple intramuscular vaccines are administered during the same visit.
`99070`	Supplies and materials provided by the physician over and above those usually included with the service	Use to report vaccine administration supplies when payer allows separate supply billing.
`96372`	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular	Alternative administration code used in some outpatient settings if immunization-specific codes are not used.

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