Contractor Information
Contractor Name:
Highmark Medicare Services, Inc.
Contractor Number:
12102, 12202, 12302, 12501, 12301, 12201, 12401
Contractor Type:
MAC Part A & B
Article Information
Article ID Number
A47549
Article Type
Article
Key Article
No
Article Title
Use of Vaccines or Inoculations for Treatment of Injury or Exposure
Primary Geographic Jurisdiction
Pennsylvania, Maryland, District of Columbia, NEW JERSEY, DELAWARE
Original Article Effective Date
07/11/2008
Article Revision Effective Date
09/01/2008
Article Ending Effective Date
N/A
Article Text
The CMS Medicare Benefit Policy Manual (IOM 100-02), Chapter 15, Section 50.4.4.2, states the following regarding the use of Immunizations: “Vaccinations or inoculations are excluded as immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin. In the absence of injury or direct exposure, preventive immunization (vaccination or inoculation) against such diseases as smallpox, polio, diphtheria, etc., is not covered. However, pneumococcal, hepatitis B, and influenza virus vaccines are exceptions to this rule.” It further states: “In cases where a vaccination or inoculation is excluded from coverage, related charges are also not covered.”
Coding Guidelines
Use of a vaccine or inoculation by a provider for the treatment of an injury or direct exposure, as described above, should be indicated by the use of the AT modifier on the submitted claim.
Refer to LCD Database # L27473 for additional information concerning drugs and biologicals. Medicare Part B providers should also refer to the Part B Reference Manual, Chapter 25, Preventive Services, for additional information about immunizations.
Coverage Topic
Immunizations, Vaccinations
Coding Information
CPT/HCPCS Codes
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
13x | Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00) |
71x | Clinic-rural health |
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
0636 | Drugs requiring specific identification-detailed coding (eff 3/92) |
Other Information
Other Comments
Additional CMS Manual guidance is found in the CMS IOM Pub. 100-04, Chapter 17, Section 10.
Revision History
Revision History Explanation
| Date | Article # | Description |
|---|---|---|
08/29/2008 |
A47549 |
Article effective 09/01/2008 for New Jersey Part A. Effective 09/01/2008, New Jersey Part A will be added to the other jurisdictions already effective: DC Part A and DCMA Part B; Maryland Part A and Maryland Part B; Pennsylvania Part A; and Delaware Part B. |
08/01/2008 |
A47549 |
Article effective 08/01/2008 for DC Part A, Maryland Part A, and Pennsylvania Part A. Article is now effective for DC Part A and DCMA Part B; Maryland Part A and Maryland Part B; Pennsylvania Part A; and Delaware Part B. |
05/23/2008 |
A47549 |
Article to become effective 07/11/2008 for Maryland Part B, DCMA Part B and Delaware Part B. |