Here are my two questions/scenarios:
1. Medicare patient receives Adacel (90715) with a diagnosis of medical necessity (direct exposure).
2. Medicare patient receives Adacel with a preventive diagnosis.
In situation 2. would the clinic be required to obtain an ABN? Also, If an ABN was not obtained, would the clinic be able to bill the patient?
I have heard a lot of conflicting information regarding this. I spoke to a Medicare rep and she said that Adacel is a covered CPT code and that the reason it would be denied would be due to the diagnosis code, thus we would be responsible for obtaining the ABN prior to administering the shot.
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