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.
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.
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