Monkeypox Diagnostic Testing Update

On August 31, 2022, the Office of MaineCare Services (OMS) released an updated bulletin regarding planned MaineCare coverage of Monkeypox diagnostic testing and vaccines.

OMS has updated our systems to include the Monkeypox diagnostic testing and you may begin to submit claims.   

As a reminder, the American Medical Association (AMA) has not released specific guidance regarding Monkeypox vaccine administration CPT codes. Please use the applicable vaccine administration codes: 90460, 90461, 90471 or 90472 on your claims.  

Please review the following tables for more information.    

Monkeypox Diagnostic Testing and Vaccination Codes    

Code     

Description     

Effective Date     

MaineCare Rate     

 87593    

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

 07/26/22    

 $35.92   

 90611    

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

 07/26/22    

 $0**  

 90622    

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

 07/26/22    

 $0**   

**Government supplied at no cost and billed with the SL modifier  

   

Vaccine Administration Codes  

Code  

Description  

MaineCare Rate  

 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  

$11.40  

 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)  

$8.64  

 90471  

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)  

$11.40  

 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)  

$8.64  

 

The Maine CDC Division of Disease Surveillance has created a website with the latest information about Monkeypox. Topics include symptoms, transmission, FAQs, and treatment options.  

Please contact your Provider Relations Specialist with questions.       

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