Practices testing or providing vaccinations for monkeypox will find it easier to bill for those services. 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.
Two vaccine codes are product-specific
Select the appropriate vaccine code based on the specific vaccine product administered:
- 90611 (Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous injection)
Use code 90611 for the JYNNEOS combined smallpox and monkeypox vaccine manufactured by Bavarian Nordic. The vaccine, also called Imvamune or Imnavex, has been FDA approved for use in patients aged 18 and older. It requires administration of two doses 28 days apart.
- 90622 (Vaccinia [smallpox] virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use).
Code 90622 describes the ACAM2000 smallpox vaccine manufactured by Sanofi Pasteur Biologics Co. for patients 12 months and older, requiring just one dose. The FDA has approved the vaccine for use against monkeypox under expanded access Investigational New Drug (IND) application.
Use one of the existing vaccine administration codes (90460, 90461, 90471 or 90472) in conjunction with the new vaccine product codes.
The AMA decided to release the new codes after the World Health Organization (WHO) declared monkeypox to be a global health emergency, according to AMA President Jack Resneck Jr., M.D., in an AMA release about the codes. With cases of monkeypox on the rise, the addition of the codes seemed timely, he stated.
“The daily increase in cases in the U.S. shows community spread occurring; however we are relieved to see access to testing has increased to 80,000 specimens per week with commercial labs now online and vaccine supply is increasing," Resneck stated.
See clinical examples, procedure descriptions and other information about the new codes
here.
UPDATE, 9/1/22: CMS has updated its instructions: When billing for vaccine administration from the government, even if you get the vaccine for free, include the product code (90611 or 90622), the applicable ICD-10-CM diagnosis code (
Z23 [Encounter for immunization]), and the administration code on the claim. CMS says it will "address the no cost government vaccine product payment adjustments during claims processing." See more
here.