Medicare TDAP (90715)

nneecole

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I have researched this exhaustively. Does Medicare pay for the Tdap (90715)? I know they will pay for the TD (90714) if there is a injury. But will they pay for the TDap (90715) if there is a injury? The LCD is confusing to me. It sounds like they will pay for it if the pt doesn't know if they have ever had a Tdap and they have a injury and are at risk. But.....can I bill it? Or does the pt have to use their Part D Medicare to buy it at a pharmacy??? I am so confused. Please help. Thank you!!
P.S. Does anyone ever use the AT modifier??
 
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Hampton, VA
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Medicare and TDap

Hi Neecole,

I work in a Family Practice office and I see denials all the time regarding Medicare and TDap. No, Medicare doesn't cover the TDap in an office setting. It might be covered under the patient's Part D benefits. Medicare Part B only covers Influenza, Pneumococcal and Hepatitis B.
 

millicent

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90715 Tdap

So, after reading this thread regarding 90715, can physician write RX for Tdap? Patient will pay & pick up at pharmacy then come to office for administration OR can pharmacy just administer shot? I am so confused. Could someone please clarify for me?

Thank you in advance!

Millicent Allen
 

jhendrix08

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It all depends on whether or not the patient has part D benefits. We no longer give the tdap to patients in our office because of the denials we were receiving; it's not covered in the office setting. Not to be confused with Td; which is covered if there is a documented injury.
If the physician recommends a tdap, the patient should check with their pharmacy to see if it's covered under their part D benefits and if so, the pharmacist can administer it for them. This is the best way to avoid confusion and possible denials. (I don't believe that it requires a Rx but don't quote me on that).

Hope that helps.
 

rthomas@impcna.com

Contributor
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If you are administering the Tdap (90715) in office setting, the only way to get paid is if there is documentation (where & how) regarding an abrasion, cut, scratch, etc. and coded. The injury dx goes attached to the 90715 & 90471 not the Z23. Also need to attach modifier AT to both codes it indicate that this vaccine was given as part of treatment for an injury.
 
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