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Wiki 90715 for TDAP

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StacyTerramiggi

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42
Location
Farmington, MO
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I work for a practice of 4 Dr.'s and 5 NP and I keep telling them that 90715 is not being paid by Medicare. Every avenue I take I am reading this is not a payable code per Medicare yet they will not take no as the answer they are stating that they are only using the code for the pertussis not for the tetanus. does anyone know if I can possibly get a payable code for this or just for the pertussis. If this is unpayable can someone please post that it is because I'm hoping if they see from others this is not payable they will accept it better. Thank you very much!!
 
I just spoke to our MAC, Novitas (Texas) and confirmed that since there is NO fee for cpt 90715, Medicare stated that we can charge patient and NO abn is needed since there is no fee schedule.

the other code 90471 is billable to medicare
So cash pay for 90715 / and 90471 bill to medicare

thank you
Lisa Tompkins, CPC
 
For Novitas I would look into the AT modifier for certain circumstances.
If the patient is being treated for an acute condition suach as a laceration, abrasion things like that. Medicare will pay if the AT modifer is appended to the vaccine and administration codes.
However, if it is given routinely then no there is no coverage.
 
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