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Billing New Monkeypox Vaccine and Laboratory Codes

On 7/23/2022, the WHO declared monkeypox a PHE. The HHS issued a statement regarding the Biden-Harris Administration’s actions to make vaccines, testing and treatments available.

The AMA CPT Editorial Panel released two new CPT codes effective for claims with dates of service on or after 7/26/2022:

Vaccine Codes

  • Code 90611 for smallpox and monkeypox vaccine product:
    • Long descriptor: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, nonreplicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use
    • Short descriptor: SMALLPOX & MONKEYPOX VAC 0.5ML
  • Code 90622 for vaccinia (smallpox) virus vaccine product:
    • Long descriptor: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
    • Short descriptor: VACCINIA VRS VAC 0.3 ML PERQ

Vaccine Administration Codes

New codes 90611 and 90622 represent the product supply. For administration, beneficiary cost sharing will apply to the administration of the vaccine, which are generally expected to be billed with CPT codes 90471 or 90472.

Billing and Payment

Include these three elements on your claim, even if you get the vaccine free from the government.

  • Vaccine code
  • Applicable ICD-10-CM diagnosis code
  • Administration code

Note: The vaccine codes will not apply to SNF CB edits.

Part A Claims

  • Types of bill to report:
    • Hospital -- 13X
    • Critical access hospital
    • 85X Report the appropriate diagnosis coded to highest level of specificity

Part B Claims

  • Report the date of service
  • Report the place of service code
  • Report the appropriate diagnosis coded to highest level of specificity

Monkeypox Laboratory Code

Code 87593 – Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (e.g., monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each.

Billing and Payment

  • This code is effective for dates of service on or after 7/26/2022
  • The payment rate for Part A and Part B has been set at $51.31

Part A Claims

  • Types of bill to report:
  • Hospital inpatient Part B -- 12X
  • Hospital outpatient -- 13X
  • Hospital other Part B -- 14X
  • Critical access hospital -- 85X

Part B claims

  • Report the date of service
  • Report the place of service code
  • Report the appropriate diagnosis coded to highest level of specificity

Claims for these services For Medicare beneficiaries enrolled in a MA should be submitted to the MA plan.

Related Content

Revised 9/6/2022

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