Tetanus and Diphtheria Vaccinations Billing GuidelinesCPT CodeICD-1090715S61011A90471S61011AAug 30, 2018
Tetanus vaccinations are eligible for Medicare Part B coverage when they are directly related to the treatment of an injury or direct exposure to a disease or condition....Avoid claim processing delays when billing tetanus vaccinations.CPT® CodeDescriptor90715Tetanus, diphtheria toxoids and acellular pertussis vaccine, older than 790471Immunization administration2 more rows•Apr 28, 2022
A35 - Other tetanus. ICD-10-CM.
Article - Billing and Coding: Tetanus Immunization (A52438)
For the TDAP vaccine, report CPT code 90715 (pays approximately $31).
Diphtheria and tetanus toxoids and acellular pertussis vaccine, pediatric formulation (replaced DTP) DTP or (DTwP)
ICD-10 requires only one code (Z23) per vaccination, regardless if single or combination. Report Z23 for all vaccination diagnoses.
ICD-10-CM Code for Encounter for immunization Z23.
According to ICD-10-CM guidelines, clinicians may assign code Z28. 310, “Unvaccinated for COVID-19,” when the patient has not received a dose of any COVID-19 vaccine. Clinicians may assign code Z28.
Medicare Part B pays for several vaccines to help prevent disease. This includes the tetanus vaccination, but it does not pay for a Tdap tetanus booster. Medicare Part D, the prescription drug plan, does cover the Tdap vaccine, and it also pays for most commercially available vaccines to prevent illness.
Medicare prescription drug coverage (Part D) usually covers all commercially available vaccines needed to prevent illness, including the Tdap shot.
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.