Wednesday, August 11, 2010

Tetanus and Diphtheria toxoids (90702, 90714, 90718) with covered DX

CPT 90702, 90714, 90718, 90296


Tetanus and Diphtheria toxoids (90702, 90714, 90718) - These injections are temporarily being covered when given for an acute injury to a person who is incompletely immunized. This is due to the limited availability of the Tetanus toxoid. ICD-9 codes: V03.7, 870.0-897.7, 910.0-919.9 When the availability of tetanus toxoid increases we may rescind coverage of these codes.

NOTE: Code 90714 is currently effective for Medicare 01/01/2006. For prior dates of service, use code 90718 to report these services.



Diphtheria, antitoxin (CPT 90296) will be covered for the treatment of diphtheria. The following ICD-9 codes will be allowed: 032.0-032.3, 032.81-032.85, 032.89, 032.9.
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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download