Monkeypox Update: Laboratory Billing

 

Monkeypox is a rare disease caused by infection with the monkeypox virus, which is related to the smallpox virus. On July 26, 2022, the American Medical Association Current Procedural Terminology (CPT) Editorial Panel created and released CPT codes to streamline the reporting of orthopoxvirus and monkeypox testing currently available in the United States, including a code for laboratory testing:

 

  • ​​​​87593: Infectious ​​agent detection by nucleic acid (DNA or RNA); orthopoxvirus
    (e.g., monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each.

 

This new code is not currently billable in fee-for-service Medi-Cal. Medi-Cal will announce when the claims adjudication system is ready, and release additional instructions providers should use when billing for a monkeypox testing code. Until then, providers are advised to administer the test when medically indicated and hold the Medi-Cal claim submission until further notice.

 

Testing is becoming more available, with several large commercial laboratories, including Labcorp, Quest, Aegis, Mayo Clinic Labs, and Sonic Healthcare, offering testing. Testing is also available by some local public health laboratories. There is no fee for public health testing, and commercial testing should be billed as indicated above. At this time, the federal government has allocated a limited number of monkeypox vaccine doses to California, and the California Department of Public Health (CDPH) is working with local health departments to make available these doses. 

 

The Department of Health Care Services will continue to update and inform all Medi-Cal providers about testing and vaccinations related to monkeypox as guidance becomes available.

 

Both the CDPH and the Centers for Disease Control and Prevention websites provide further guidance on monkeypox symptoms, testing, treatment, and vaccination.

Last modified date: 8/1/2022 2:55 PM