Date: September 9, 2022
To: Enrolled Physicians; Advanced Practice Registered Nurses; Physician Assistants; Local Health Departments; Hospitals; Federally Qualified Health Centers; Rural Health Clinics, Encounter Rate Clinics; School-Based/Linked Health Centers; and Independent Laboratories
Re: Monkeypox Testing and Vaccine Administration
This notice identifies to providers the monkeypox laboratory testing code, rate, and monkeypox vaccine administration policy. This applies to testing and vaccination for customers covered under Medicaid fee-for-service (FFS) or a HealthChoice Illinois (HCI) managed care organization (MCO) plan.
Effective with dates of service beginning July 26, 2022, providers should utilize CPT code 87593 to bill for monkeypox virus testing. CPT code 87593 is defined as follows:
87593 - Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (e.g., monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each.
The Department of Healthcare and Family Services' (HFS) pricing for the lab test is consistent with other testing fees at 60% of the Medicare rate. The Medicaid rate for the lab test is $30.79.
The Illinois Department of Public Health advises providers to consult their local health departments for testing and vaccination guidance for suspected cases of monkeypox.
The monkeypox vaccine is available free of charge from the federal government. No charges for the actual vaccine should be submitted. There are currently two vaccines available:
- ACAM2000 (single dose)
- Jynneos (2 doses)
According to HFS policy, reimbursement for the practice expense of administering injections is included in the office visit when the customer sees a practitioner. No separate administration fee is payable. If the customer is seen solely for the injection, the CPT code for a minimal level office or other outpatient visit for evaluation and management not requiring the presence of a physician may be submitted to cover the injection service expense.
The Practitioner Fee Schedule will be revised to include the lab code and rate at its next scheduled update. In the interim, this notice serves as verification of coverage and payment.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or to the applicable HCI MCO plan.
Kelly Cunningham, Administrator
Division of Medical Programs