Billing Mpox vaccine and laboratory codes

Mpox and smallpox vaccine and administration

On July 26, the American Medical Association (AMA) CPT Editorial Panel released the new codes 90611 (Smallpox and Mpox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use) and 90622 (Vaccinia [smallpox] virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use). These codes are effective for dates of service on or after July 26. This article will assist Medicare providers with proper billing relating to the new Mpox and smallpox vaccines.

Billing and payment

• Patient cost sharing applies to the administration codes.

Vaccine and administration codes

Mpox laboratory code

On July 26, the AMA created the new code 87593 (Infectious agent detection by nucleic acid [DNA or RNA]; orthopoxvirus [e.g., Mpox virus, cowpox virus, vaccinia virus], amplified probe technique, each MD: IADNA ORTHOPOXVIRUS AMPLIFIED PROBE TECHNIQUE EA) for diagnostic testing. 

Billing 

Part A claims

• Report the appropriate date of service
• Types of bill to report:
  • Hospital inpatient Part B -- 12X
  • Hospital outpatient -- 13X
  • Hospital other Part B -- 14X
  • Critical access hospital -- 85X
• Report the appropriate diagnosis coded to highest level of specificity

Part B claims

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

References

• MLN Connects for September 1, 2022