CPT 91319 SARS–CoV‑2 Vaccine Reimbursement | OpenPayer

Summary & Overview

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

CPT code 91319 identifies a SARS–CoV–2 vaccine product (tris–sucrose formulation) supplied as a 10 mcg/0.3 mL intramuscular dose. As a vaccine product code, 91319 is used to denote the vaccine itself in billing and supply chains and is distinct from administration procedure codes. This code matters nationally because COVID–19 vaccination remains a core public health measure with wide-ranging payer coverage, supply tracking implications, and reporting requirements.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the clinical product and service context, a summary of typical sites of service, and an overview of payer relevance. The publication outlines where this product code fits in billing workflows, highlights common modifiers associated with vaccine billing (listed separately), and identifies missing input fields where applicable. Policy updates, reimbursement benchmarks, and clinical implications relevant to national vaccination programs are summarized to provide context for providers, billing staff, and policymakers.

Data not available in the input: associated taxonomies, ICD-10 diagnoses, related procedure codes, service line details, and payer-specific reimbursement rates.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare91319CPTSARS-CoV-2vaccineintramuscular injectionCOVID-19 vaccinationvaccine productimmunization billing

Billing Code Overview

CPT code 91319 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 is 10 mcg/0.3 mL. This is a vaccine product code describing the vaccine itself rather than the administration procedure.

Service type: Vaccine product (SARS–CoV–2), intramuscular formulation

Typical site of service: Outpatient clinics, vaccination sites, pharmacies, and other ambulatory settings where intramuscular vaccines are administered

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult or adolescent presenting to a medical office, pharmacy immunization clinic, public health clinic, or employer-sponsored vaccination event to receive a SARS–CoV–2 mRNA vaccine (tris–sucrose formulation) given intramuscularly at a 10 mcg/0.3 mL dose. The encounter includes check-in, screening for contraindications and allergies, verification of COVID-19 vaccination history, informed consent, administration of the intramuscular injection (deltoid), and a 15–30 minute observation period for acute allergic reaction monitoring. Documentation includes vaccine product identifier 91319, lot number, expiration date, route (intramuscular), dose, site, VIS (Vaccine Information Statement) issuance, and billing details. Typical sites of service are outpatient clinic, pharmacy, public health clinic, and temporary vaccination sites.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier — standard reporting	Use when no special circumstances or modifiers apply to the administration.
`22`	Increased procedural services

CPT 91200: Liver Elastography for Lesion Characterization

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-91323-MRNA-COVID19-VACCINE-10MCG-0-2ML-IM-IMMUNIZATION

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

CPT-91318-SARS-COV-2-VACCINE-TRIS-SUCROSE-3MCG

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

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

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

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 and preventive vaccinations.
`208D00000X`	General Internal Medicine	Internists routinely provide COVID-19 vaccination in outpatient settings.
`3336C0001X`	Clinical Pharmacist	Pharmacists administer vaccines in pharmacies and clinic-based immunization programs.
`207L00000X`	Pediatric Medicine	Pediatrics administers COVID-19 vaccine to eligible children and adolescents.
`364S00000X`	Public Health Practice	Public health nurses and practitioners deliver mass vaccination clinics and outreach services.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z23`	Encounter for immunization	Primary code used to indicate encounter for administration of vaccine to prevent disease.
`U07.1`	COVID-19, virus identified	May be used in contexts where current or recent SARS–CoV–2 infection is relevant to vaccine timing or contraindications.
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when vaccine is given as part of a routine preventive visit for pediatric patients.
`Z76.89`	Persons encountering health services in other specific circumstances	Used for non-routine vaccination events such as employer clinics or mass-immunization drives.
`Z51.89`	Other specified aftercare	Used when vaccination is part of follow-up care or post-exposure considerations in specific protocols.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`90471`	Immunization administration (intramuscular, single)	Billed for the act of administering a single intramuscular vaccine when separate from the vaccine product code; often reported alongside the vaccine product code when payer requires.
`90472`	Each additional vaccine administration (intramuscular or subcutaneous)	Used when multiple vaccines are administered during the same visit in addition to the primary vaccine.
`90460`	Immunization administration via any route, first vaccine/toxoid component (for vaccines requiring counseling)	Used when counseling is provided and specific payer rules require this administration code for counseling-intensive immunizations.
`90471`	Immunization administration, intramuscular (duplicate entry intentional to reflect common pairing)	Commonly paired with vaccine product reporting; ensure single correct administration code is billed per payer policy.
`99212`	Office or other outpatient visit for the evaluation and management of an established patient, low complexity	May be used when an E/M service is documented and meets medical necessity separate from vaccine administration; use `25` modifier when billed same day.
`G0008`	Administration of influenza vaccine (Medicare specific historically)	Example of vaccine administration HCPCS/G-code historically used by payers; relevant as a comparison for vaccine administration reporting and payer-specific rules.

OpenPayer