Coming Soon: Monkeypox Vaccines as Medi-Cal Benefits
August 5, 2022
Currently, two vaccines may be used for the prevention of monkeypox virus infection, although no data is available yet on the effectiveness of these vaccines in the current outbreak:
- JYNNEOS (also known as Imvamune or Imvanex), is licensed (or approved) by the U.S. Food and Drug Administration (FDA) for the prevention of monkeypox virus infection
- ACAM2000, licensed (or approved) by the FDA for use against smallpox and made available for use against monkeypox under an Expanded Access – Investigational New Drug Application.
Please note that currently these vaccines are not directly available to providers but rather to states. The California Department of Public Health (CDPH) continues to work with local health departments to preposition treatment and vaccine doses to ensure that the vaccines are available quickly to those most in need. To date, the state has distributed more than 25,000 vaccine doses to local public health departments and mobile clinics and will make additional allocations in the coming days and weeks. The state allocates doses to local health departments based on a number of factors, including the number of reported monkeypox cases in an area and estimated number of at-risk populations.
These vaccines are a Medi-Cal benefit when administered in accordance with U.S. Food and Drug Administration approval, recommendations from the Centers for Disease Control and Prevention, and when billed on a medical claim. The American Medical Association identified the vaccine and administration billing codes at the end of July 2022. The Department of Health Care Services (DHCS)is waiting for additional guidance from the Centers for Medicare and Medicaid Services related to the appropriate Medicare/Medicaid reimbursement rates for each code. DHCS will provide additional information regarding the billing methodology and reimbursement rates as soon as they are finalized.
As these services are currently Medi-Cal benefits, providers should administer vaccines according to CDPH/county guidelines and hold their claims until further billing instruction is established and published. Providers will be able to submit claims for retroactive payment.
For the most recent dose prioritization information or availability of additional doses and expansion of vaccination to a larger group, see the guidance from CDPH on its Monkeypox Vaccination homepage.
The Department of Health Care Services will continue to update and inform all Medi-Cal providers on testing and vaccinations related to monkeypox as guidance becomes available.
Both the California Department of Public Health and Centers for Disease Control and Prevention websites provide further guidance on monkeypox symptoms, testing, treatment and vaccination.