Novitas Solutions says it won't pay Medicare claims for administering tetanus shots that do not have the modifier AT (acute treatment) appended to the code. The medical record must support the need for the service and the use of modifier AT.
Medicare excludes vaccinations unless they relate directly to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin. The only preventive immunizations Medicare pays for are pneumococcal, hepatitis B, and influenza virus vaccines.
Action, May 15, 2013