Coding Guide for Monkeypox testing and Vaccines codes

In response to the emergent nature of the public health concern surrounding monkeypox, the Current Procedural Terminology (CPT) Editorial Panel (the Panel) has approved three new codes specific to monkeypox. The Panel approved one CPT code (87593) to report the laboratory diagnostic testing for the orthopoxvirus and two new vaccine product codes (90611, 90622) for the smallpox and monkeypox combined vaccine (JYNNEOS) and the traditional smallpox vaccine (ACAM2000), respectively.

 When to use CPT code 87593

87593 Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each

Reporting code 87593 will help streamline the tracking of and reimbursement for testing services related to monkeypox in the United States. To meet the needs of the Centers for Disease Control and Prevention (CDC) safety-monitoring programs and to track the specific testing performed, it is imperative the appropriate code is listed on claim forms.

 When to use Vaccine CPT codes 90611 & 90622

90611 Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, nonreplicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous injection

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

Vaccine product code 90611 describes the JYNNEOS combined smallpox and monkeypox vaccine. The JYNNEOS vaccine, also referred to as Imvamune or Imnavex, has been approved by the FDA for use in patients aged 18 years and older and requires the administration of two doses 28 days apart. Use in younger patient populations requires the submission of an application under the expanded access IND. Note that due to the current limited supply of the JYNNEOS vaccine, its use should be prioritized for patients who are at risk for severe adverse events from the ACAM2000 smallpox vaccine or at risk for severe disease from monkeypox (ie, people who are severely immunocompromised, including those with human immunodeficiency virus [HIV]). People who receive the JYNNEOS vaccine are considered fully vaccinated 2 weeks after their second vaccine dose is administered.

Vaccine product code 90622 describes the ACAM2000 smallpox vaccine product for patients aged 12 months and older and requires the administration of only one dose. The Food and Drug Administration (FDA) has approved the smallpox vaccine for use against monkeypox under the expanded access Investigational New Drug (IND) application. The monkeypox virus is closely related to the virus that causes smallpox (both are in the orthopox family of viruses). Thus, the smallpox vaccine can provide some protection against getting monkeypox. ACAM2000 is a live
vaccine; therefore, precautions need to be taken as the lesion caused by vaccine administration may transmit the infection to others if they come into close contact with it. People who receive the ACAM2000 vaccine are considered fully vaccinated 4 weeks after vaccine administration.

Existing CPT vaccine administration codes (90460, 90461, 90471, 90472) should be used to report the administration of the vaccine products described by codes 90611 and 90622 depending on the age of the patient and the administration(s) provided during the encounter.

Clinical example of CPT code 87593

A 45-year-old male presents with skin lesions, fever, and lymphadenopathy after potential exposure to monkeypox. Swabs of skin lesions are obtained for polymerase chain reaction (PCR) testing.

DNA is isolated and polymerase chain reaction (PCR) is performed for detection of orthopoxvirus genus or member species. Results are reported.

Clinical example of CPT code 90611

A 36-year-old male who is at risk for exposure to an orthopoxvirus (ie, monkeypox virus) presents for vaccination.
The physician or other QHP determines that the orthopoxvirus (ie, monkeypox virus) vaccine is appropriate for this patient and dispenses the vaccine according to the dose scheduled for the orthopoxvirus (ie, monkeypox virus) vaccine.

Clinical example of CPT code 90622

A 36-year-old male who is at risk for exposure to an orthopoxvirus (ie, smallpox virus) presents for vaccination.

The physician or other QHP determines that the orthopoxvirus (ie, smallpox virus) vaccine is appropriate for this patient and dispenses the vaccine according to the dose scheduled for the orthopoxvirus (ie, smallpox virus) vaccine.

References:

https://www.ama-assn.org/system/files/cpt-assistant-guide-monkeypox-july-2022.pdf