The purpose of this memo is to notify ADAP and PrEP-AP enrollment workers of updates to MPX resources and services. On August 4, 2022, MPX was declared a United States (U.S.) public health emergency. The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau engaged with federal partners across the U.S. Department of Health and Human Services (HHS), including Centers for Disease Control & Prevention (CDC) to provide resources to assist health care providers and patients in combatting the spread of MPX.
On July 26, 2022, the American Medical Association (AMA) released an update to the Current Procedural Terminology (CPT) that includes specific orthopoxvirus laboratory testing and two CPT codes being utilized for vaccines to prevent and treat MPX infection. The codes, outlined below, will be added to the allowable services lists.
| 87593 | Infectious agent detection by nucleic (DNA or RNA); orthopoxvirus (e.g., MPX virus, cowpox virus, vaccinia virus), amplified probe technique, each | A new laboratory test to describe molecular diagnostic testing that detects the nucleic signature of an orthopoxvirus, including MPX virus |
| 90611 | Smallpox and MPX vaccine, attenuated vaccinia virus, live, nonreplicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous injection | JYNNEOS vaccine for the prevention of smallpox and disease in adults 18 years of age and older. Used for high-risk individuals for MPX and smallpox infections |
| 90622 | Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use | ACAM2000 vaccine for active immunization against smallpox disease for high-risk individuals with smallpox infection |
ADAP and PrEP-AP Coverage
At this time, MPX vaccines and treatments are being provided by the U.S. federal government. In accordance with federal guidance, ADAP and PrEP-AP will assist eligible clients with covering fees associated with vaccine administration and treatment of MPX. ADAP will cover labs, medical out of pocket costs, anatomical site administration, and related insurance copays and deductibles. For ADAP to cover these expenses, uninsured ADAP and PrEP-AP clients must have active ADAP eligibility and ensure providers within the ADAP/PrEP-AP provider network are offering the vaccines and treatment before scheduling an appointment.
Insured ADAP and PrEP-AP clients can also access MPX services from a provider within their insurance network. The in-network provider will be responsible for ensuring the client's insurance is billed for the administration of MPX. Clients with insurance must see a provider within their insurance network and PAI can assist with reimbursement for medical out of pocket (MOOP) costs. The client/provider would need to submit a MOOP claim form (PDF) along with supporting documentation (including an Explanation of Benefits) to PAI for processing. Providers are required to submit completed W9s to PAI prior to PAI remitting payment.
Resources:
ADAP will continue to monitor the situation and update this memo as necessary. Please contact your OA Advisor if you have any questions regarding the information provided in this memo.
Thank you,
Sharisse Kemp, MSW
ADAP Branch Chief
Office of AIDS
California Department of Public Health