Wiki Medicare Tdap and Hep B vaccines....................

[nneecole44]

I have two questions. I have researched this extensively. I just need some guidance.

1. Does Medicare pay for the Tdap or not? I was always under the understanding that Medicare does not pay for the Tdap. Ever. Just a TD if there is a injury. Then I came across this:

https://www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=34596&ver=36&CntrctrSelected=151*1&Cntrctr=151&s=36&DocType=Active&bc=AggAAAQBAAAA&

I thought the Tdap was not a Medicare benefit. I am so freaked out. LOL. So it can be billed? Any special way? Modifier?

2. When a (Medicare) patient has a Hep B vaccine due to a lab test showing no immunity does it need to be bill in a certain way? Special modifier?

Thank you so much!

 

[erjones147]

The only time I have ever gotten a TDAP paid for by Medicare is if it was given as a result of something like "stepped on rusty nail," etc. Then I would append modifier -AT

Otherwise, Medicare never covers TDAP to my knowledge

For Hep B, I always just code as 90746, G0010 and get paid every time w/ mod -25 on the OV

 

[nneecole44]

Thank you. So my next question is.....Are you saying it is covered with a injury? I thought it was Tdap statutorily excluded/not a medicare benefit. I am trying to decide what if any modifier to use. The patient signed a ABN. There was no injury. The patient just wanted one. I am sorry if I am confusing. I am confused. Thank you sooooo much.

 

[erjones147]

To the best of my knowledge, Medicare does pay for Tdap with a qualifying diagnosis and modifier -AT

As for the rest, I work at a tribal health clinic so we don't deal with ABNs or cash pays; we just give the shot and write it off