I am trying to find the LCD list for Medicare on the 90718 code. I didn't think Medicare covered thid code but I was told if you had the appropriate dx due to the injury they would pay for it. However I could not find the LCD list on the fcso website. Could someone please send me the link.
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Wiki 90718 Tetanus Toxid
- Thread starter martyzal
- Start date
abyrne
Networker
This is not typically covered for preventive purposes. This link may be helpful.
http://www.wpsmedicare.com/part_b/policy/active/local/_files/l16791_l16792_l16793_l16794_alrg003.pdf
http://www.wpsmedicare.com/part_b/policy/active/local/_files/l16791_l16792_l16793_l16794_alrg003.pdf
KellyLR
Expert
90718
I don't do vacs but I went for the challenge at CMS and this is what you can do:
I didn't know which state, carrier, etc. but look up CMS, Medicare Coverage, general Info, Medicare Coverage Database, Overview, then on left side of screen click Search and the dialog box will ask you for the CPT code. I looked it up under Trailblazer, for example, and found this dated and effective 1/1/2007:
Tetanus (90703, 90714, 90718) - These injections are covered when given for an acute injury to a person who is incompletely immunized.
When a tetanus booster is given to a patient in the absence of an injury, the injection does not meet the coverage criteria for Medicare (even though it may be appropriate preventive treatment).
Article Number: I-80A-R2 (A39821)
I hope this example will point you in the right direction
KellyLR
I don't do vacs but I went for the challenge at CMS and this is what you can do:
I didn't know which state, carrier, etc. but look up CMS, Medicare Coverage, general Info, Medicare Coverage Database, Overview, then on left side of screen click Search and the dialog box will ask you for the CPT code. I looked it up under Trailblazer, for example, and found this dated and effective 1/1/2007:
Tetanus (90703, 90714, 90718) - These injections are covered when given for an acute injury to a person who is incompletely immunized.
When a tetanus booster is given to a patient in the absence of an injury, the injection does not meet the coverage criteria for Medicare (even though it may be appropriate preventive treatment).
Article Number: I-80A-R2 (A39821)
I hope this example will point you in the right direction
KellyLRjdibble
True Blue
Need a Modifier
Our Medicare carrier, Highmark, will pay for medically necessary tetnus, however we have to append modifier AT to the drug and administration for it to pay, even with the dx of open wound. They will not pay for the charges for preventive reasons.
Jodi Dibble, CPC
Our Medicare carrier, Highmark, will pay for medically necessary tetnus, however we have to append modifier AT to the drug and administration for it to pay, even with the dx of open wound. They will not pay for the charges for preventive reasons.
Jodi Dibble, CPC