CMS updates instructions on billing Medicare for smallpox and monkeypox vaccines

Following the recent release of new Current Procedural Terminology codes for smallpox and monkeypox vaccines, the Centers for Medicare & Medicaid Services (CMS) has updated its guidance on how to bill Medicare for their administration.

On Aug. 11, CMS originally said to only bill for vaccine administration when you get the vaccine at no cost from the government. On Sept. 1, CMS announced the correct instructions are to include these three elements on your claim, even if you get the vaccine from the government for free:

1. Product code,
2. Applicable ICD-10-CM diagnosis code,
3. Administration code.

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

As a reminder, the product codes are:

• 90611 (Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use),

• 90622 (Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use).

The applicable ICD-10-CM code for vaccine administration is Z23 (Encounter for immunization administration).

There are currently no new administration codes for 90611 and 90622, which means you should use the following codes when you administer the vaccines to your patients:

• 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered),
• + 90461 (… ; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)),
• 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid),
• +90472 (…; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)).

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

— Kent Moore, AAFP Senior Strategist for Physician Payment

Posted on September 16, 2022