Medicaid Coverage of Monkeypox Testing and Vaccination
On August 29th, following the Biden Administration’s declaration of the Monkeypox Public Health Emergency, the Pennsylvania Department of Human Services issued a Medical Assistance Bulletin to healthcare providers enrolled in the Medicaid Fee-for-Service system providing information on how to bill for Monkeypox testing and vaccination. The bulletin includes the appropriate procedure codes adopted from the American Medical Association. Medicaid recipients are limited to one test and one vaccine per day. Prior authorization is not required. Healthcare providers in the managed care delivery system are directed to contact the appropriate Managed Care Organization (MCO) with questions about Monkeypox coverage and protocols.
To learn more about Monkeypox, click here for information from the Centers for Disease Control and Prevention. If you think you have been exposed to Monkeypox or are at risk of exposure, the Department of Health is encouraging people to contact their health provider, local health department, or call 1-877-PA-HEALTH for help.
If you are a Medicaid recipient and you receive a denial for Monkeypox testing or vaccine coverage, or are having trouble accessing these services, please call PHLP’s Helpline at 1-800-274-3258.