The Pharmacist’s Billing Guide to the Vaccine for Monkeypox/Mpox
Despite the fall in reported cases of Monkeypox (now transitioning to being called Mpox1) since the peak in August 2022, people all over the country have found themselves asking: “what is this disease and is there a monkeypox vaccine?” Unfortunately, in-depth patient and community member knowledge and understanding of monkeypox and smallpox vaccines is limited. So, pharmacists, drug manufacturers, and other providers are often the ones left filling in the gaps.
Patients may approach their pharmacist to ask if they should get a vaccine for monkeypox/mpox.Because there is no certain objective criteria to answer this question, pharmacists should develop their counseling points to assure all customers and patients are receiving the same information and level of care.
As a pharmacist, if you haven’t been keeping up-to-date with all the most recent news regarding the monkeypox vaccine (USA and abroad), there’s no need to worry. In this guide, we will detail all the information you need, including the different types of monkeypox vaccine, where to get supplies, who is qualified to administer them, and details on billing procedures.
What is Monkeypox and is it still a threat?
Monkeypox is a rare viral disease that can cause symptoms similar to smallpox, although it is generally less severe. It is found primarily in certain parts of Africa, although there have been a few reported cases in other countries. As of Jan 4, 2023, there have been about 84,000 cases worldwide with 30,000 total cases and 20 deaths in the U.S. The number of cases rose drastically over the summer of 2022 and have since tapered off, according to the CDC.
Though we heard about it frequently in the news over the summer, it is not common in the United States; however, as we saw, it is possible for people in the U.S. to become infected if they are exposed to the virus. It is important to take precautions to avoid exposure to the virus, such as through avoiding contact with those that have been infected, washing your hands, and getting vaccinated.
As a pharmacist, it is important to be prepared in order to protect your patients from an outbreak of mpox.
Is There a Monkeypox Vaccine?
There are two types of vaccines for monkeypox that are approved by the Food and Drug Administration (FDA):
JYNNEOS is the preferred monkeypox vaccine for USA residents and the variety most commonly available to the public. It is produced by Denmark’s Bavarian Nordic and consists of two shots administered four weeks apart. Supplies are currently limited. However, millions more doses are expected to arrive within the first half of 2023. JYNNEOS vaccine contains small amounts of gentamicin and ciprofloxacin and is produced using chicken embryo fibroblast cells, therefore allergy screening should be performed prior to recommending or administering this vaccine.
Vaccine providers should be familiar with identifying immediate-type allergic reactions, including anaphylaxis, and be competent in treating these events at the time of vaccine administration. Providers should also have a plan in place to contact emergency medical services immediately in the event of a severe acute vaccine reaction. (ACIP Adverse Reactions Guidelines for Immunization).
ACAM2000 is an older smallpox vaccine for monkeypox, approved under a special access protocol to treat the recent outbreak. This is a single shot, which is manufactured by Emergent Product Development Gaithersburg, Inc. under the Emergent BioSolutions parent organization. However, ACAM200 has the potential for more side effects than the Jynneos shot — particularly for pregnant women, those with already weakened immune systems, and anyone with pre-existing skin and heart conditions.
Both vaccines are currently being released from the Strategic National Stockpile, and can be obtained by contacting the Centers for Disease Control and Prevention (CDC).
Of course, not many patients are likely to ask you outright:* “is there a monkeypox vaccine for pregnant women?”* or “is there a monkeypox vaccine for people with immune/skin/heart conditions?”That’s why it’s essential to conduct an adequate medical review and ask important questions about the patient’s medical history and allergies before you decide which to administer. You’ll also likely have to navigate a few other frequently asked questions, including:
- Question: Is there a monkey pox vaccine for children?
- Answer: The risk of children contracting monkeypox is relatively low. However, as of August 9, 2022, the Emergency Use Authorization (EUA) issued by the FDA allows Jynneos to be given as a postexposure prophylaxis (PEP) for children and adolescents under 18 who are deemed high-risk.
- Question: Can you get monkeypox if you had the smallpox vaccine?
- Answer: Routine smallpox vaccinations have not been available in the USA for some time after the World Health Assembly declared the virus eradicated in 1980. However, many older people may have had the shot in their youth. So, if you had a smallpox vaccine, are you immune to monkeypox? There is no definitive answer for now, as it’s currently unclear how long smallpox vaccination protection lasts against monkeypox. However, it is important to remind patients that, while the monkeypox virus is part of the same family of viruses as smallpox, they are not one and the same.
Am I Eligible to Administer the Monkeypox Vaccine?
The Department of Health and Human Services (HHS) moved quickly to expand the workforce authorized to administer monkeypox vaccines. As of September 30th, 2022, pharmacists, pharmacy interns, and pharmacy technicians are all approved to prescribe, dispense, or administer the vaccine for monkeypox. The authorization extends to pharmacists and technicians whose licensure has lapsed or expired in the past five years.
However, the following requirements must be met:
1. Vaccinations must be ordered and administered according to the CDC’s Advisory Committee on Immunization Practices.
2. Healthcare professionals and students alike must have documentation of completing the relevant CDC-provided or CDC-recommended training. In the absence of training requirements or recommendations from the CDC, other training(s) may be substituted if:
3. The training is approved or accredited by a national or state-recognized accrediting body or association, the FDA, or an equivalent organization.
4. You receive hands-on instruction for the administration route as appropriate for the countermeasure, supervised by a professional who administers within their normal scope of practice.
5. Training includes clinical evaluations of indications or contraindications, and the recognition and treatment of emergency reactions to smallpox (variola virus), monkeypox virus, or other orthopoxvirus countermeasures.
6. Anyone administering the Jynneos vaccine for monkeypox or ACAM2000 smallpox vaccine for monkeypox must have documentation of competency. This should be provided after a period of observation under a currently practicing healthcare professional experienced in the appropriate preparation and administration within their ordinary scope of practice. Examples of preparation that require documentation of competency include:
7. Intradermal, subcutaneous, or intramuscular injections
8. Dermal/percutaneous scarification
9. Intranasal or oral administration
10. Any vaccine administrator must have a current certificate in basic cardiopulmonary resuscitation (CPR).
11. Any healthcare professional administering monkeypox and smallpox vaccines must adhere to their jurisdiction’s recordkeeping and reporting requirements, including:
12. Informing the patient’s primary care provider (when available).
13. Submitting the required immunization information to the state or local immunization information system (vaccine registry)
14. Complying with requirements for reporting adverse events.
15. Reviewing the vaccine registry or other vaccination records prior to administering a vaccine.
16. All administrators must comply with the applicable requirements (or conditions of use) outlined in the CDC provider agreement, and any other federal requirements.
Billing Procedures for Monkeypox Vaccines
Unfortunately, there is minimal billing guidance for monkeypox vaccines, which can cause issues for pharmacists. The team at DocStation understands this frustration, and we are dedicated to streamlining the billing process. As part of our overarching goal to help health plans and pharmacies collaborate to improve outcomes and minimize the total cost of care, we have collected the most essential information for you to better serve your patients.
According to CMS, Medicare will cover medically necessary monkeypox tests under Part B, meaning beneficiaries will generally not be responsible for any cost-sharing (although there may be some state-by-state exceptions).
The Current Procedural Terminology (CPT®) Editorial Panel approved three new codes specific to monkeypox:
- 87593 – For reporting the laboratory diagnostic testing for the orthopoxvirus
- 90611 – For the Jynneos vaccine product
- 90622 – For the ACAM2000 vaccine product
Please note that while these codes do not appear in the CPT 2022 code set, they are published on the AMA website and will be included in the CPT 2023 code set. In addition, the CPT® Assistant Special Edition and direction from the CMS provides guidance and examples of how the new codes should be used, along with continued usage of existing vaccine administration codes such as:
- 90460 – The first or only component of an immunization for patients under the age of 18 via any route of administration, with counseling by physician or other qualified healthcare professional.
- 90461 – Any additional vaccine or toxoid component administered to a patient under the age of 18 (listed separately in addition to code for the primary procedure).
Report codes 90471–90472 for immunization administration of any vaccine that is not accompanied by face-to-face physician or other qualified health care professional counseling the patient and/or family, or for patients over 18 years of age.
- 90471 – The first or only component of an immunization for adults over the age of 18 via any route of administration, including percutaneous, intradermal, subcutaneous, or intramuscular injections.
- 90472 – Any additional vaccine or toxoid component administered to a patient over the age of 18 (listed separately in addition to code for the primary procedure).
Even though new codes are added constantly, DocStation is a resource you can refer to for updates on billing codes.
Monkeypox Vaccine Billing Made Easy with DocStation
If you’ve been dealing with the complexity surrounding monkeybox billing codes or are still struggling to get your services paid from summer of 2022, chances are the question you’re also asking is: Is there a monkeypox vaccine billing solution that can meet your pharmacy’s needs?
At DocStation, we’re revolutionizing the world of medical invoicing with FHIR-standardized pharmacy billing software. Whether you’re a single community pharmacy or a large chain, our simple and intuitive cloud-based care platform enables you to transform the tests and vaccines you provide into payments by:
- Submitting pharmacy claims digitally, without the need for a CMS-1500.
- Sharing data with those who need it, when they need it.
- Receiving reimbursement support, so you know you’ll always get paid for your eligible work.
- Providing patients with seamless service in a world where their experience is usually an afterthought.
DocStation’s pharmacy software integrates effortlessly with your existing systems, meaning your records will always be up to date. Contact us today to learn more about how to manage your patients more effectively, and discover the power of a partnership with DocStation.
Ready to work smarter? Learn more about DocStation here.
1. WHO recommends new name for monkeypox disease. Accessed January 5, 2023. https://www.who.int/news/item/28-11-2022-who-recommends-new-name-for-monkeypox-disease#:~:text=Mpox%20will%20become%20a%20preferred,midst%20of%20a%20global%20outbreak.
2. JYNNEOS Vaccine. Accessed January 14, 2023. https://www.cdc.gov/poxvirus/monkeypox/interim-considerations/jynneos-vaccine.html