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YBoyd said:
What would the correct coding/billing be for Medicare (Colorado)
Pt received Pneumo20, TDAP, PPD test for retirement community.
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You can find the Medicare coverage and coding guidelines for preventive services here: Preventive Service Chart

The pneumovax is a covered benefit under Part B, but the TDAP and PPD are not. If the patient has Medicare Part D, it may cover the TDAP. Otherwise, the patient or their secondary insurance, if they have one, will be responsible for those.
 
YBoyd said:
What would the correct coding/billing be for Medicare (Colorado)
Pt received Pneumo20, TDAP, PPD test for retirement community.
Click to expand...
90677 (PCV20 Vaccine) & G0009 (Pneumonia vaccine admin) DX: Z23, 90715 (Tdap Vaccine) & 90471 (Tdap admin) DX: Z23, and 86580 (PPD test) DX: Z11.1 - Medicare does not cover Tdap vaccine as preventative as only covers for injuries and/or high risk wounds.
 
melihas said:
Do you know how much Medicare allows for the PCV 20? I can't seem to find anything on their website.
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Yes we have been billing PCV20 for Medicare insurance and being reimbursed. PCV20 is for 65yrs old and older & 19-64 yrs old w/certain underlying medical conditions or risk factors.
 
njycarter17 said:
Yes we have been billing PCV20 for Medicare insurance and being reimbursed. PCV20 is for 65yrs old and older & 19-64 yrs old w/certain underlying medical conditions or risk factors.
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Yes I do know that. I'm trying to figure out how much Medicare pays for the PCV20. What is the allowable amount?
 
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