CMS’s August 11 edition told providers to only bill for vaccine administration when they got the vaccine at no cost from the government. The correct instructions are to include these three elements on claims, even if providers receive the vaccine from the government free:

1. Product code (90611 pr 90622)
2. Applicable ICD-10 diagnosis code
3. Administration code

CMS will address the no cost government vaccine product payment adjustments during claims processing. Providers will see it on the remittance advice.

Code 90611 for smallpox and monkeypox vaccine product:

• Long descriptor: Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5mL dosage, suspension, for subcutaneous use
• Short descriptor: SMALLPOX & MONKEYPOX VAC 0.5ML

Code 90622 for vaccinia (smallpox) virus vaccine product:

• Long descriptor: Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use
• Short descriptor: Vaccinia VRS VAC 0.3ML PERQ

Patient cost sharing applies. Your Medicare Administrative Contractor will give you more information soon about coverage and billing.

Source: CMS MLN Connects dated September 1, 2022