Tetanus and Diphtheria Vaccinations Billing Guidelines

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

CPT Code Description
90714 Tetanus and diphtheria toxoids (Td) older than age 7
90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap)
90471 Immunization administration
90472 Immunization administration


Claim example - Medically necessary tetanus vaccination

 CPT Code ICD-10
90715 S61011A
90471 S61011A


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

CPT Code Modifier
90714 GY
90471 GY


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

Incorrect ICD-10 Code Description
S61219A Laceration w/o fb of unsp finger w/o damage

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.

Correct ICD-10 Code ICD-10 Description
S61011A Laceration w/o fb of right thumb w/o damage

Last Updated Thu, 30 Aug 2018 10:47:47 +0000