Wiki Cpt 90715 with 90471 - Can anyone tell me

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More
W
Cpt 90715 with 90471

Medicare Part B always covers three routine preventive immunizations: pneumococcal pneumonia (PPV), influenza, and hepatitis B when the patient is at intermediate or high risk for contracting Hepatitis B. Exceptions for immunization after exposure to disease
According to Medicare Local Coverage Determination (LCD) L34596 (see Priority Health website), the immunizations listed below are covered by Medicare Part B when:
• There has been direct exposure of the associated disease to the patient, and
• There is significant risk that the patient could contract the disease as a result of the exposure.
Coverage applies ONLY to:
• Diptheria, antitoxin (CPT code 90296)
• Hepatitis A (CPT codes 90632, 90633, 90634)
• Immune globulin subject to the requirements of L30147, Immune Globulins
• Rabies prophylaxis (CPT codes 90675, 90676)
• Tetanus and diphtheria toxoids (CPT codes 90702, 90714, 90715)
For any other codes, you must follow the pre-service organization determination process to obtain a notice of non-coverage and/or approval for the immunization. If we deny the request and provide you and the member with a notice of the denial, you may then bill with the GA modifier to show that notice was given.

trose45116

Expert
Messages
307
Location
cincinnati
Best answers
0
Can anyone tell me if there is another cpt code that needs to be billed when patient has medicare. Im getting denials on these codes.

Thanks
 

dclark7

True Blue
Messages
723
Location
Hartford, CT
Best answers
0
Vaccinations or innoculations are excluded from medicare coverage unless they are directly related to the treatment of an injury or direct exposure to a disease. The exceptions to this are flu and pneumonia, and also for high or intermediate risk benficiaries Hep B. The Medicare Benefit Policy Manual (100-02 chapter 15 and chapter 16) has this information.
 

andersont

Guru
Messages
105
Best answers
0
tetanus

Patient is responsible for the Tetanus. If you get an ABN signed, you can bill the patient for the administration also. Make sure you place modifier GA on the adm. I use 90703 if there was an injury or wound and Medicare pays it.
 
Messages
3
Best answers
0
Billing 90715 to MCR

According to an article published by the CDC in June of 2012, they recommeded Tdap for patients 65 and older. Titled" Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Adults Aged 65 Years and Older" — Advisory Committee on Immunization Practices (ACIP), 2012

Does MCR fall in line with this? It seems that since we have been billing the 90715, we are still being denied payment.

Any guidance on this topic would be appreciated.
 

darlene.dean@lpnt.net

Contributor
Messages
15
Best answers
0
Some Part D plans cover immunizations. Our clinic administers Boostrix and Zostavax. You might want to look into using TransactRx to process your claims. Their phone number is 866-522-EDVM. We verify Part D coverage and co-pay amounts on their website and they submit the claims to the Part D plans for us. There is a small fee which is deducted from each check we receive from them. Email me if you want more info. darlene.dean@lpnt.net Hope this helps!
 

Lynda Wetter

True Blue
Local Chapter Officer
Messages
511
Location
Richmond Virginia
Best answers
0
Depending on your jurisdiction, the AT modifier should be applied.
"For tetanus and rabies vaccines to be covered for payment, the patient must have undergone a recent injury or direct exposure. Providers have been instructed to report modifier "at" indicating acute treatment for these recent injury or direct exposyre situations. Effective dates of service October 11,2007 and after, this edit has been set up to allow payment for the tetanus and rabies vaccines only if the AT modifier is being reported"
"90696, 90703, 90714, 90715, 90718, 91675, 90676 and admistration codes 90471, 90472"

This was a buliten that crossed my desk for Part B Maryland and Pennsylvania locations.

hope this helps
 
Top