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.