Billing and Coding: Tetanus Immunization

Medicare covers tetanus immunization only when administered for a wound or documented direct exposure to Clostridium tetani; routine preventive tetanus vaccination without injury/exposure is not covered. If a provider knows a service is non-covered or not a Medicare benefit, the GY modifier must be appended to the CPT/HCPCS code, and complete, legible medical record documentation (including supporting ICD-10-CM and CPT/HCPCS coding and provider signature) must be maintained and produced upon request.

"Tetanus immunization is covered when given for a wound or documented direct exposure to Clostridium tetani (injury-related or exposure-related prophylaxis)."

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