Tetanus Toxoid (CPT 90703)
Immunizations, vaccinations, or inoculations are covered by Medicare only when there has been direct exposure of the associated disease to the patient and there is significant risk that the patient could contract the disease as a result of the exposure. They are not covered as routine immunizations. Each specific immunization has specific coverage criteria.
Vaccine Code: 90703 (Tetanus toxoid absorbed) Administration Code: 90471 (Immunization Administration) Diagnosis code: 892.10 (complicated open wound on foot) E920.8 (puncture wound by nail)
Tetanus Toxoid (CPT 90703)
These injections are covered when given for an acute injury to a person who is incompletely
1. One booster injection in a patient who has had primary immunization, has sustained a high-risk wound (a wound which affords anaerobic conditions or which has been incurred in a circumstance with probability of exposure to tetanus spores), and has not received the booster within the last 5 years.
2. When a patient has not received primary immunization or the primary immunization status is not known, and the patient has sustained a high-risk wound. Coverage includes:
a. The initial injection;
b. A second injection in 1 month; and
c. A third injection 6-10 months later.
d. Also, see policy INJ-012 for immune globulin coverage.
3. When a tetanus booster is given to a patient in the absence of an injury/potential exposure, the injection does not meet the coverage criteria for Medicare (even though it may be appropriate preventative treatment). Preventative services should not be billed to Medicare.
Guideline from UHC
Immunizations are generally excluded from coverage under Medicare unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment or tetanus antitoxin or booster vaccine. In the absence of injury or direct exposure, preventive immunizations (vaccination or inoculation) against such diseases as smallpox, typhoid and polio, are not covered. In cases where a vaccination or inoculation is excluded from coverage, the entire charge will be denied (such as office visits which are primarily for the purpose of administering a non-covered injection).
Medicare Covered for Tetanus Vaccine: The below injections are covered when given for an acute injury to a person who is incompletely immunized. When the tetanus booster is given to a patient in the absence of an injury, the injection does not meet the coverage criteria for Medicare (even though it may be appropriate preventive treatment).
90703 Tetanus vacc, IM All ages $53.93
90702 Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use
90714 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use
90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
Medicare Covered for Administration of Tetanus and/or Rabies Vaccines: Administration codes for the tetanus and rabies vaccinations must also meet coverage criteria.