In September 2022, the Centers for Disease Control & Prevention and the U.S. Food & Drug Administration both approved Emergency Use Authorization for updated bivalent COVID-19 booster vaccines for adolescents and adults. For pediatric practices, this booster arrives at a busy time of year, and there are many questions: Can you deliver flu vaccines and COVID-19 at the same time? How can you sort out who has received which dose and when? To answer these questions, in this post we’ll cover the logistics of drive-thru and in-office clinics, plus the latest we know about the vaccine.
The Bivalent COVID-19 Booster Shot
The latest bivalent booster vaccines received Emergency Use Authorization (EUA) by the CDC and FDA in early September, 2022. Depending on the manufacturer, adolescents and young adults are eligible for the new boosters: Pfizer-BioNTech’s bivalent booster is for ages 12 and older, while Moderna’s is for adults 18 and older. For most pediatric practices, it will be expedient to order the new Pfizer-BioNTech booster vaccine.
In October 2022, the FDA approved bivalent boosters for children aged 5 to 11. While the rollout for bivalent vaccines to independent practices will be slower than they are for larger healthcare systems like hospitals, pediatricians can expect receipt of doses for adolescents as soon as October 2022.
Which vaccine goes to which child? According to AAP News, “The Pfizer-BioNTech bivalent booster emergency use authorization that includes people 12 years and older has been expanded to include children ages 5-11 years. The Moderna bivalent booster authorization for those 18 and older has been expanded to include children and adolescents ages 6-17 years.”
When entering the new booster vaccines into your EHR system, it will be important to distinguish their names from other COVID-19 booster doses, as the new bivalent dose is now recommended, while the former monovalent booster dose is no longer recommended. For more information about CPT codes and naming conventions for the COVID-19 vaccines and boosters, please visit the American Medical Association’s website.
How did we get here? Approval for another booster dose has been debated. Find out more about the approval process and the future of what COVID-19 vaccines might look like in this long-form interview with Dr. Paul Offit, MD FAAP, a pediatrician specializing in infectious diseases, vaccines, immunology, and virology.
Do you have questions about how pediatricians should approach delivering vaccines and boosters, and in which order? The AAP lists a full breakdown of the current COVID-19 vaccines and boosters available, as well as recommendations for the complex vaccine order protocols. For example, if a patient is 11 and turning 12 before the second shot of their primary series they may either receive the appropriate pediatric dose or the adult dose or a combination thereof. See the AAP’s full breakdown for more examples.
Vaccination Opportunities in Pediatrics
The introduction of the COVID-19 bivalent booster vaccine for adolescents and young adults brings opportunities for pediatric practices – not only to provide the boosters for teens, but also to ensure that families are up to date on their vaccination schedules, well visits, screenings, and many more important milestones.
When considering a vaccine clinic for COVID-19 or simply a recall program to fill your practice’s schedule for COVID-19 boosters, your practice may also consider opportunities to maximize care for teen patients and even their tagalong siblings. Choose goals that offer the most impact in order to reduce confusion, logistical errors, and burnout.
For example, you may choose to only focus on giving COVID boosters and flu vaccines (the CDC approves and encourages this). On the other hand, if your practice has noted a low HPV vaccination rate, it may be more efficacious to focus on COVID-19 boosters and HPV vaccine recall – or simply to add “recall eligible HPV vaccine patients” to your COVID booster workflow.
The AAP has also stressed the importance of equitable vaccine opportunities for all children. The Centers for Disease Control (CDC) have recommended that the COVID-19 vaccine and booster be included in the Vaccines for Children program, which provides free vaccines to Medicaid-eligible, uninsured, underinsured, and American Indian/Alaska Native children. For more information on VFC in your state, you can check the CDC’s master list here.
Ready to start offering vaccines en masse? Drive-thru and in-person clinics are a great way to reach many patients in a short period.
Hosting a Vaccine Event at Your Practice (or Elsewhere)
The PCC blog has covered drive-thru flu and other vaccine clinics before – check out this post for lots of information about where and how to host your vaccine event, from parking lot permissions to getting the vaccines in arms. Here’s a brief summary:
- For drive-thru clinics: choose a safe location approved by your landlord or property owner
- Set up can be minimal, but you may benefit from tents, an outdoor table, a wifi extender, and a 2D scanner for vaccines
- Safety first, always. Offer signage for traffic directions, and be sure every vehicle is parked before approaching
- Promote your event via social media, in person, or in your patient communications like email or text
- Prepare materials beforehand, such as vaccine information sheets (VIS). Be sure to let parents know that COVID-19 cards are required.
- Pre-register all patients where possible to gauge the correct staffing volume. Reward and support staff during this busy period.
To reiterate: while your practice can and should offer additional services during your vaccine event, such as adding on a sibling for a vaccine, choosing a primary focus like COVID vaccines only or a combination flu-COVID event can reduce confusion and make the process easier for staff and families. Where appropriate, a front desk staff member can be on site to schedule patients requiring other vaccines or care for a future date.
Getting Paid for the COVID-19 Booster
At the time of this post’s writing, it is unclear how payors will pay providers for the new bivalent COVID-19 vaccines. The American Academy of Pediatrics, as well as the AMA and other medical professional organizations, are advocating for parity with similar previous COVID-19 payments. You can find out more about coding, billing, and getting paid for all COVID-19 vaccines from the AAP’s Coding Newsletter and the AAP’s COVID-19 updates page. PCC clients have access to the AAP’s Coding Newsletter included in their subscription.
While boosters will be effective in protecting children and young adults against evolving strains of COVID-19, pediatricians and parents are still left with questions: will an under-12 pediatric bivalent booster become available? When? How will the COVID-19 pandemic continue to evolve? As we learn more information about COVID-19 boosters, PCC will continue to provide the latest information and expert advice both on this blog and from our COVID-19 Resources Page.