This article is for all providers caring for our members
In response to the monkeypox public health emergency, we would like to provide guidelines on how to bill for the administration of the monkeypox vaccine.
As a reminder, modifier SL is used to indicate a non-reimbursed, state-supplied vaccine. The monkeypox vaccine will be accepted if billed with or without modifier SL. See our Immunization payment policy for additional guidelines.
As a reminder, modifier SL is used to indicate a non-reimbursed, state-supplied vaccine. The monkeypox vaccine will be accepted if billed with or without modifier SL. See our Immunization payment policy for additional guidelines. To download our payment policies, log in and click Find a Payment Policy on the right side of your home page. Or, go to Office Resources>Policies & Guidelines>Payment Policies.
To report vaccine administration, bill the existing vaccine administration codes (90460, 90461, 90471, 90472) according to the patient’s age and the administration(s) given during the visit.
Code | Description | Comments |
---|---|---|
90611 | Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous injection | Not reimbursed as the vaccine is provided free from the state |
90622 | Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use | |
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 | Use to report the administration of 90611 or 90622 |
90461 | Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; 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 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure) |
If you have any questions, please call Network Management and Credentialing Services at 1-800-316-BLUE (2583). As always, thank you for the care you provide to our members.
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