Wiki Medicare Adminstration Code for Tetanus

[CMW]

Does anyone use G0377 for the administration of a Tetanus shot for Medicare patients? We have been billing 90471 and Medicare is not paying for it! I understand that only Part D will pay for the toxoid (90715) but doing the vaccine in a Family Practice office and patient has Part D, shouldn't they pay for the administration of the vaccine?

Any advice would be AWESOME!

 

[CBaer]

Administration Code for Tetanus

It is my understanding that Medicare does not reimburse for routine vaccination with the exception of Flu, Pnuemonia & Hep B.

Per Novitas Solutions, Bulletin: Tetanus Vaccine 03/21/2013

Vaccinations or inoculations are excluded as immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin. In the absence of injury or direct exposure, preventive immunization is not covered. However, pneumococcal, hepatitis B, and influenza virus vaccines are exceptions to this rule.

CMS reference: Benefit Policy Manual, 100-02, Chapter 15, Section 50.4.4.2.

 

[aharoldsen]

CMS believes that Part D vaccines, including the associated administration costs, should be billed on one claim.

MLN Matters Number: SE0727

We usually either have the patient get the Zoster and TDAP at a pharmacy. Pharmacist are trained to give injections. If the patient does not feel comfortable with a Pharmacist giving the injection, then we require the patient to purchase the vaccine at the pharmacy, so it is covered, then our nurses will inject it as a courtesy (no charge) to the patient.