The AMA has published updates to the Current Procedural Terminology (CPT®) code set to include newly assigned provisional codes for vaccines to protect patients against the H5N8 strain of highly pathogenic avian influenza (HPAI), often referred to as “bird flu.”
These CPT codes, updated by the CPT Editorial Panel, will be effective for use if vaccine candidates receive emergency-use authorization from the U.S. Food and Drug Administration (FDA). While the current public health risk is low, the update is being published now to ensure health systems across the country are prepared in advance of potential FDA authorization.
There is no immediate recommendation to start vaccination of the general public or specific at-risk populations. However, federal agencies are actively planning for potential H5 vaccination, including beginning to stockpile vaccine should it be needed.
“The new CPT code is a vital preparatory step in response to the potential danger to humans from a highly infectious avian influenza disease,” said AMA President Bruce A. Scott, MD, a Louisville, Kentucky-based otolaryngologist.
“A CPT code that clinically distinguishes the avian influenza vaccine allows for data-driven tracking, reporting and analysis that supports planning, preparedness, and allocation of vaccines in case a public health response is needed for avian flu prevention,” Dr. Scott added.
Here are the CPT updates
The new product code assigned to H5N8 influenza virus vaccines is:
90695: Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted for intramuscular use.
The new CPT code for H5N8 influenza virus vaccines should be used with one of the following administration codes to report the work counseling patients or caregivers, administering the vaccine and updating the medical record.
For children (through 18 years old) the administration codes are:
90460: Immunization administration through 18 years old via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered.
90461: Immunization administration through 18 years old via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered.
For adults the administration codes are:
90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid).
90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid).
Short, medium and long descriptors for all the new vaccine-specific CPT codes can be found in the AMA Bird flu (H5N1) resource center, along with several other recent modifications to the CPT code set that have helped streamline the public health response.
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CDC monitoring continues
Highly pathogenic avian influenza (HPAI) A(H5N1) virus is a type of influenza virus that causes highly infectious and severe respiratory disease in birds. It is causing outbreaks in poultry and dairy cows in the U.S. And while the current public health risk for the general public is low, the Centers for Disease Control and Prevention (CDC) is carefully watching the situation and working with states to monitor people with animal exposures.
Human cases have been reported in Colorado, Michigan and Texas.
The CDC reports that, since April 2024, 13 human cases of avian influenza A(H5) infection have been reported in the U.S. Four were associated with exposure to sick dairy cows and nine with exposure to avian influenza A(H5N1)-infected poultry.
Meanwhile, the CDC is spending $5 million on outreach and educational efforts and working with partner organizations to protect farmworkers’ health and safety.
The agency will spend another $5 million to offer seasonal flu vaccines to livestock, dairy and poultry workers. The seasonal influenza vaccine won’t prevent infection from bird flu, the CDC said, but it will reduce strain on rural health systems and, if fewer people get the seasonal flu, it will help public health workers better detect if a person is sick with avian flu.
Changes to the CPT code set are considered through an open editorial process managed by the CPT Editorial Panel that collects broad input from the health care community and beyond to ensure CPT content reflects the coding demands of digital health, precision medicine, augmented intelligence, and other aspects of a modern health care system. This rigorous editorial process keeps the CPT code set current with contemporary medical science and technology.
