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Tetanus inj with injury..........

  1. Default tetanus without an injury?
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    I am getting denials for annual exams with a tetanus without injury, why would they deny this? Isn't it best to prevent the elderly from getting this?
    Any help would be appreciated.

  2. #12
    Location
    Richmond Virginia
    Posts
    501
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    I found this clip on the link below

    http://www.medicareinteractive.org/p...script_id=1519

    I would check your local MAC and see their guidelines. Also remember the 90471 bundles with Office visits and if requirements are met it may need the 25 modifier.


    ***Medicare covers some vaccines and immunizations. The way Medicare covers them depends on which vaccine you need.

    Your Medicare Part B will cover vaccines to prevent:
    ?Influenza (the flu); ◦Currently, the seasonal flu shot includes both a seasonal flu shot and an H1N1 (swine flu) vaccination.

    ?Pneumonia; and
    ?Hepatitis B (if you are at medium to high risk).

    Part B will cover other immunizations only if you have been exposed to a dangerous virus or disease. For example, if you step on a rusty nail, Medicare will cover a tetanus shot; if you are bitten by a dog, Medicare will cover your rabies shots.
    Note: Original Medicare covers the influenza, pneumonia, and Hepatitis B vaccines with no coinsurance or deductible if you see a provider who accepts assignment. Providers who accept assignment cannot charge you more than the Medicare approved amount. Medicare Advantage (MA) plans will cover all preventive services the same as Original Medicare. MA out-of-pocket costs for vaccines and immunizations will vary depending on the type of shot. Your costs will also vary depending on if you go to an in-network or out-of-network provider.

    All vaccines other than those for the flu, pneumonia or hepatitis B are covered under Medicare Part D. If you have a Medicare prescription drug plan (Part D), you can get coverage for any commercially available vaccine that is not covered by Part B. All Part D plans must include all commercially available vaccines on their formularies, including the vaccine for shingles (herpes zoster). Your Part D plan will pay for the vaccination itself and for your doctor or other health care provider to give you the shot (administration). Before you get a vaccination, you should check coverage rules with your Part D plan and see where you should get your shot so that it will be covered for you at the lowest cost.

  3. Default
    Medicare prices potentially-covered vaccines in the drug ASP files found at http://www.cms.gov/Medicare/Medicare...4ASPFiles.html

    90703 Tetanus vaccine, im 0.5 ML 39.026
    90714 Td vaccine no prsrv >/= 7 yo, im 0.5 ML 21.154
    90715 Tdap => 7 yo, im 0.5 ML 33.603

    Also be sure to check the MAC for your area for specific instructions, for instance the LCD at this link includes all of the above codes as covered when an injury is the indication for the vaccination http://www.cms.gov/medicare-coverage...AAAAAAA%3d%3d&

  4. #14
    Location
    Richmond Virginia
    Posts
    501
    Default
    Quote Originally Posted by Cynthia Hughes View Post
    Medicare prices potentially-covered vaccines in the drug ASP files found at http://www.cms.gov/Medicare/Medicare...4ASPFiles.html

    90703 Tetanus vaccine, im 0.5 ML 39.026
    90714 Td vaccine no prsrv >/= 7 yo, im 0.5 ML 21.154
    90715 Tdap => 7 yo, im 0.5 ML 33.603

    Also be sure to check the MAC for your area for specific instructions, for instance the LCD at this link includes all of the above codes as covered when an injury is the indication for the vaccination http://www.cms.gov/medicare-coverage...AAAAAAA%3d%3d&
    Yes this is covered when there is an injury. However, I believe the person posting was asking if it is covered when given routinely.
    If you are in the Novitas are they do require the AT modifier to be applied to the vaccine and admin charges.
    Also note this article is for Part A medicare not Part B. So this would not necessarily apply to the Office setting when providing annual care.
    Last edited by Lynda Wetter; 06-03-2014 at 01:51 PM.

  5. #15
    Location
    Richmond Virginia
    Posts
    501
    Default
    You can also do a search in the Medicare Pub100 for tetanus and see it is only covered for injuries.

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