Medicare Physical and Immunizations

We did a Medicare physical today and will be billing G0439. The patient also got a Tdap immunization which I know is not covered by Medicare but she wanted one (we had her sign an ABN) and she also received the pneumococcal vaccine. So my question is this. If you are using both G0009 for the vaccine administration and 90471 for the immunization administration do I need to put a modifier on one of them? Or would it be the same as when you use a 90471 and a 90472? I plan on billing like this: G0439, 90471, 90715-GX, G0009, and 90732. I just don't know if that is right. Hope this question makes sense. Thank you for any help with this!

re: Medicare Physical and Immunizations

We add modifier 59 to the G0009 when billing with 90471.