Billing and Coding: Tetanus Immunization

Medicare covers tetanus toxoid administration when directly related to treatment of an injury or potential exposure: one booster for high‑risk wounds if >5 years since last booster, and boosters for clean/minor wounds only if >10 years since last booster. Primary series completion and immunization for inadequately vaccinated or unknown‑status patients are supported in the context of wound management; preventive immunizations given absent injury/exposure are not covered. Claims must include valid ICD‑10 diagnosis codes, appropriate ordering/referring physician identifiers, and follow ABN/coding rules (NCCI/OPPS, place of service, and UB‑04/FL reporting requirements).

"One tetanus booster dose is covered for a patient who completed primary immunization, has sustained a high‑risk wound (anaerobic conditions or probable exposure to tetanus spores), and has not rece..."