For Medicare claims, to report the tetanus vaccine administered for treating an injury or direct exposure to a disease or condition, append modifier AT (acute treatment) to the code for the vaccine.
In a March 21, 2013, bulletin, Novitas says claims submitted without modifier AT will be denied.
The medical record must support the need for the service and the use of modifier AT.
Vaccinations or inoculations are excluded from Medicare coverage as immunizations unless they are directly related 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. In the absence of injury or direct exposure, Medicare does not pay for preventive immunization. However, pneumococcal, hepatitis B, and influenza virus vaccines are exceptions to this rule.
Published April 9, 2013
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