The U.S. Centers for Medicare & Medicaid Services (CMS) had announced in August 2022 to only bill for monkeypox & smallpox vaccine administration when you got the vaccine at no cost from the government. CMS has now clarified that the correct instructions are to include these 3 elements on your claim, even if you get the vaccine from the government for free:

  1. Product code (90611 or 90622)
  2. Applicable ICD-10-CM diagnosis code
  3. Administration code

CMS will address the no cost government vaccine product payment adjustments during claims processing. You will see it on your remittance advice.

Code 90611 for smallpox and monkeypox vaccine product:

  • Long descriptor: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, 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

Patient cost sharing applies. Your Medicare Administrative Contractor will give you more information soon about coverage and billing.

Source: U.S. Centers for Medicare & Medicaid Services (CMS)

About 3Gen
3Gen Consulting has always been in the forefront when it comes to adding value. We always believe in setting our own standards. What sets us apart is the investment that we make in our people, processes and innovation to provide you with market leading healthcare revenue cycle management services. We work as an extension of our clients’ teams by focusing on their key challenges, aligning with their culture and delivering the best results.

If you’re interested in finding the right medical billing and coding services partner, contact us today.

Get In Touch!
close slider

    Get In Touch!