Wiki Medicare TDAP (90715)

nneecole44

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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??
 
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.
 
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
 
Try to bill it with a primary diagnosis of the puncture wound, if it was not performed as a routine, but due to the wound. We got them paid last year.
 
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.
 
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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