Resource AMA new codes -Monkeypox

The CPT Editorial Panel has approved the addition of code 90622 to identify vaccinia (smallpox) virus vaccine product; and the addition of code 90611 to identify monkeypox and smallpox virus vaccine product.

90611: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use

90622: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use

Laboratory test code​
87593​	Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each​

What is Monkeypox?

Mpox Vaccines

Mpox is a rare disease caused by infection with the Mpox virus. In the United States, there is currently evidence of person-to-person disease transmission. CDC is urging clinicians in the U.S. to be alert for patients who have rash illnesses consistent with Mpox. The AMA keeps you current on the...

www.ama-assn.org

CPT Assistant for Monkeypox

https://www.ama-assn.org/system/files/cpt-assistant-guide-monkeypox-july-2022.pdf

Orthopoxvirus and monkeypox coding & guidance

Find CPT® codes for reporting orthopoxvirus and monkeypox testing and immunizations.

www.ama-assn.org

 

[MICHELLEK_76201]

Hello,
Need help on the fee schedules for monkeypox.

87593
87471
90611
90622

Thanks Michelle

 

[Lori]

The AMA on July 26 issued one new clinical lab test code and two vaccine codes for the virus, effective for use immediately.

New orthopoxvirus test code

In the microbiology section of CPT lab codes, the AMA has added:

• 87593 (Infectious agent detection by nucleic acid [DNA or RNA]; orthopoxvirus [eg, monkeypox virus, cowpox virus, vaccinia virus]. Amplified probe technique, each).

The code describes polymerase chain reaction (PCR) testing of a swab sample from a skin lesion obtained from a symptomatic patient.

Monkeypox Vaccine and Vaccine Administration
Fee Schedule
The American Medical Association (AMA) has announced new vaccine-specific Current
Procedural Terminology (CPT®) codes to report immunizations for the monkeypox and
smallpox virus. The Federal government is currently sponsoring the vaccine ingredient. In
response, the Medicaid fee-for-service (FFS) program is reimbursing for the administration of
the vaccine. The following fee schedule is a summary of the codes, their descriptions, their
effective dates, and the FFS reimbursement rate.
NOTE: Institutional providers should bill for vaccine and vaccine administration on
a professional claim to receive reimbursement.

Monkeypox and Smallpox Vaccine Fee Schedule
The program will provide reimbursement for vaccine administration when the federal
government covers the ingredient cost. The reimbursement will be the higher of
(1) The VFC administration rate or
(2) 100% of the CMS-designated vaccine administration code for that vaccine.

Do not bill vaccine administration codes 90460-90474, when billing for the administration of
vaccines that are provided at no charge by the Federal Government, please use the specific
vaccine ingredient code and -SE modifier in Block 24D.

Modifiers SE and SL reported by physicians or other health care professionals indicates a service has been funded or a vaccine was provided free of charge by the state or federal government; therefore, no cost has been incurred requiring reimbursement.

SE – Two definitions:
o State and/or federally-funded programs/services
o Ambulance transportation from scene of accident or acute event
to residential, domiciliary, custodial facility (nursing home, not skilled
nursing facility)
SL – State supplied vaccine

Existing CPT vaccine administration codes (90460, 90461, 90471, 90472) should be used to report the administration of the vaccine products described by codes 90611 and 90622 depending on the age of the patient and the administration(s) provided during the encounter but it is unclear if this is for during the period the government is paying the cost & these codes are to be used after or only when Medicare is not involved.

New Monkeypox Codes Effective Immediately

The CPT® Editorial Panel approved 2 vaccine codes and 1 lab code. In response to the monkeypox outbreak, the American Medical Association (AMA) has In response to the monkeypox outbreak, three new CPT® codes are effective July 26, 2022, to report lab testing and vaccination.

www.aapc.com

https://www.ama-assn.org/system/files/cpt-assistant-guide-monkeypox-july-2022.pdf

2022-08-11-MLNC | CMS

Thursday, August 11, 2022 News

www.cms.gov