# cpt 90715 no ABN



## trose45116 (Nov 7, 2012)

Can we bill patients that have mediare and no ABN was received for the DTAP immunization??? Its been a while since I have done this. I thought you were not able to but just need a refresher if you can or not.


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## mbuskirk@rrohio.com (Nov 7, 2012)

Pretty sure if there is an injury Medicare will pay.  If its just to update immunizations they wont pay.


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## trose45116 (Nov 7, 2012)

can we bill the patients if we have no ABN on file if its not related to an injury????


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## Evelyn Kim (Nov 8, 2012)

The only way I know of to bill a Medicare pt with no ABN on file is if the service is statutiorly not covered by MC.  No ABN is needed in that case.


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## dclark7 (Nov 9, 2012)

Most immunizations (except for flu and pneumonia, they might be another) are excluded from Medicare coverge.


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## trose45116 (Nov 10, 2012)

ok so does that mean i can bill the patients for cpt 90715??? i have done surgery the last 5 years and have lost some of my knowledge with doing e/m coding. im slowing getting everything together with physician coding and billing.


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## kvangoor (Nov 12, 2012)

Yes, since Medicare part B never covers these (IMM's for prophylactic reasons) you can bill the patient. I would suggest that they contact their part D carrier (covers drugs and meds) and try to get reimbursed for this.


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## barbsalim (Nov 15, 2012)

Hep B is covered also, but that is it. I get confused by Medicare terminology but I understand that if you don't get an ABN then the patient is not liable for the service and you basically eat it. I also get from the Medicare terminology that if you don't get an ABN and provide a service you know they don't cover they consider it fraud. Do I have this right or wrong? I am very new to medical billing.


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## lara1388 (Mar 26, 2018)

*ABNs for possibly non covered Medicare charges.*

It is my understanding, that if the service is not considered by Medicare, no fee schedule for CPT, then you do not need the ABN. It is only when there is a possible Medical Necessity consideration. Is that correct?


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## smatt58 (May 30, 2018)

*90715*

Would you add a modifier GY to 90715 when it is for an immunization only?


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