Medi-Cal Coming Soon for Family PACT: Orthopoxvirus Laboratory Test

Effective for dates of service on or after August 17, 2022, the Department of Health Care Services (DHCS) will reimburse CPT^® code 87593 (infectious agent detection by nucleic acid [DNA or RNA]; orthopoxvirus [e.g., monkeypox virus, cowpox virus, vaccinia virus], amplified probe technique, each) as a Family Planning, Access, Care and Treatment (Family PACT) Program benefit for the duration of the federal monkeypox (Mpox) Public Health Emergency declared by U.S. Health and Human Services.

The orthopoxvirus laboratory test is a Family PACT benefit for use as a diagnostic test for patients with skin lesions suspicious for Mpox infection when furnished in connection to a family planning visit, as a family planning-related service.

DHCS will announce when the claims adjudication system is prepared to adjudicate submitted claims for the orthopoxvirus laboratory test under Family PACT, as well as any additional instruction providers should utilize when billing. Until then, providers are advised to administer the test in accordance with the requirements above, and hold the claim submission until further notice.

An Erroneous Payment Correction (EPC) will be implemented to reprocess denied claims with dates of service on or after the effective date of this billing policy, that were appropriately submitted based on the guidance published in this article, but erroneously denied because DHCS had not yet implemented the system changes to support appropriate adjudication.

Source: https://files.medi-cal.ca.gov/pubsdoco/newsroom/newsroom_31823_13.aspx