Home > Claims, Coding, Payment
Web Content Viewer
Web Content Viewer
Monkeypox vaccine billing guidelines
September 9, 2022

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.

  • We do not reimburse monkeypox vaccine codes 90611 and 90622, as they are provided free from the state.
  • We do reimburse the administration of the vaccine.
  • Although we do not reimburse monkeypox vaccine codes, you still need to bill these codes along with the related administration codes on your claim.

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)

Questions?

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.

MPC_083122-1E-1