Tetanus and Diphtheria Vaccinations Billing Guidelines - JE Part B

The Medicare Part B program covers the tetanus vaccine (and other tetanus vaccine preparations that include diphtheria or pertussis components) is only covered as part of a therapeutic regimen of an injury. For example, if the beneficiary needs a tetanus vaccination that is related to an accidental puncture wound, the vaccination and administration would be covered under Part B. If the beneficiary needs a tetanus vaccine booster shot that is unrelated to an injury or illness, the vaccination and administration code will deny noncovered as there is no benefit category. The beneficiary may check with their Medicare Part D plan for possible coverage.

Tetanus and Diphtheria Vaccination CPT Codes and Descriptors

Claim example - Medically necessary tetanus vaccination

Claim example - Routine tetanus vaccination service. It is recommended to append the GY modifier.

When submitting the claim, append the ICD-10 diagnosis code of highest specificity.

Medical documentation must support the service billed and include a specific body part where the injury occurred as well as documentation of the vaccination given.