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Old 11-02-2012, 12:12 PM
trose45116 trose45116 is offline
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Default Cpt 90715 with 90471

Can anyone tell me if there is another cpt code that needs to be billed when patient has medicare. Im getting denials on these codes.

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Old 11-02-2012, 12:51 PM
dclark7 dclark7 is offline
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Vaccinations or innoculations are excluded from medicare coverage unless they are directly related to the treatment of an injury or direct exposure to a disease. The exceptions to this are flu and pneumonia, and also for high or intermediate risk benficiaries Hep B. The Medicare Benefit Policy Manual (100-02 chapter 15 and chapter 16) has this information.
Doreen Clark, CPC, CPMA
Medical Auditing Specialist
Integrated Physicians Management Services
East Harftord. Ct
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Old 11-02-2012, 03:07 PM
andersont andersont is offline
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Default tetanus

Patient is responsible for the Tetanus. If you get an ABN signed, you can bill the patient for the administration also. Make sure you place modifier GA on the adm. I use 90703 if there was an injury or wound and Medicare pays it.
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Old 01-22-2013, 03:10 PM
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Default Billing 90715 to MCR

According to an article published by the CDC in June of 2012, they recommeded Tdap for patients 65 and older. Titled" Updated Recommendations for Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccine in Adults Aged 65 Years and Older" — Advisory Committee on Immunization Practices (ACIP), 2012

Does MCR fall in line with this? It seems that since we have been billing the 90715, we are still being denied payment.

Any guidance on this topic would be appreciated.
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Old 01-24-2013, 07:23 AM
darlene.dean@lpnt.net darlene.dean@lpnt.net is offline
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Some Part D plans cover immunizations. Our clinic administers Boostrix and Zostavax. You might want to look into using TransactRx to process your claims. Their phone number is 866-522-EDVM. We verify Part D coverage and co-pay amounts on their website and they submit the claims to the Part D plans for us. There is a small fee which is deducted from each check we receive from them. Email me if you want more info. darlene.dean@lpnt.net Hope this helps!
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Old 01-24-2013, 09:27 AM
CoderGirl CoderGirl is offline
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Depending on your jurisdiction, the AT modifier should be applied.
"For tetanus and rabies vaccines to be covered for payment, the patient must have undergone a recent injury or direct exposure. Providers have been instructed to report modifier "at" indicating acute treatment for these recent injury or direct exposyre situations. Effective dates of service October 11,2007 and after, this edit has been set up to allow payment for the tetanus and rabies vaccines only if the AT modifier is being reported"
"90696, 90703, 90714, 90715, 90718, 91675, 90676 and admistration codes 90471, 90472"

This was a buliten that crossed my desk for Part B Maryland and Pennsylvania locations.

hope this helps
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