Tetanus and Diphtheria Vaccinations Billing GuidelinesCPT CodeICD-1090715S61011A90471S61011AAug 30, 2018
Routine tetanus vaccination services are not covered by Medicare. If you are billing for a routine tetanus vaccination, it is recommended to append the GY modifier.
Code Z23 is used to indicate any encounter for a vaccination. The procedure codes are used to identify the type of the immunization given and how it was administered.
Group 1CodeDescription90714TETANUS AND DIPHTHERIA TOXOIDS ADSORBED (TD), PRESERVATIVE FREE, WHEN ADMINISTERED TO INDIVIDUALS 7 YEARS OR OLDER, FOR INTRAMUSCULAR USEJ1670INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS1 more row
2022 ICD-10-CM Diagnosis Code T50. A15A: Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter.
Medicare prescription drug coverage (Part D) usually covers all commercially available vaccines needed to prevent illness, including the Tdap shot.
If the immunization is related to exposure (eg, the administration of a Tdap vaccine as a part of wound care), the ICD-10 code describing the exposure should be used as the primary diagnosis code for the vaccine, and Z23 should be used as the secondary code.
For the TDAP vaccine, report CPT code 90715 (pays approximately $31).
Z23 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
Updated February 2018VaccineAbbreviation*Diphtheria, tetanus and pertussis vaccines (P=Pediatric, A=Adult)Tetanus and diphtheria toxoids adsorbed (A)TdTetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine, adsorbed (A)TdapTetanus toxoid (P, A)TT52 more rows
Medicare covers tetanus shots, but the reason you need one will determine which part pays for it. Medicare Part B covers tetanus shots after an injury or illness. Medicare Part D covers the regular tetanus booster shot. Medicare Advantage plans (Part C) also cover both types of shots.
Code Z23, which is used to identify encounters for inoculations and vaccinations, indicates that a patient is being seen to receive a prophylactic inoculation against a disease. If the immunization is given during a routine preventive health care examination, Code Z23 would be a secondary code.