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:
- Product code (90611 or 90622)
- Applicable ICD-10-CM diagnosis code
- 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)
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