If they have insurance, they should go back to their physician. If they went to the ER, the ER should have done it. I ran into this with my husband-ER forgot to ask when last Td was given and when I looked up he was fine. Medicare will not pay for Td unless given in a setting which the wound was treated – I think—I would have to check on that. But Rhonda is right, can’t use 317 on insured unless you have proof their insurance won’t cover it.