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Last Modified: 4/14/2022 Location: FL, PR, USVI Business: Part A, Part B

Immunization roster billing

Roster billing may be used when immunizations are offered for large groups of beneficiaries in Public Health Centers (PHCs), shopping malls, grocery stores, senior citizen homes, or health fairs.
Roster billing is not available for hepatitis B vaccinations.
Roster billing only applies to COVID-19 vaccines, monoclonal antibody (mAb) infusions, influenza and pneumococcal immunizations.

Roster billing for Part A providers

Part A providers who use direct data entry (DDE) pdf file can submit roster bills by following the steps below:
To access the roster bill entry page, choose option "2" claims/attachments) and then select option "87" (roster bill entry).
The page allows providers to enter COVID-19, mAb, pneumococcal and influenza vaccinations in a roster bill form. When completing the roster bill, providers should observe the following points:
Only one date of service per roster page
Submit for either COVID-19, mAb, pneumococcal or influenza vaccinations. Do not combine more than one vaccination type on the same claim.
A maximum of 10 patients per roster page may be reported on a DDE roster page
Press F9 to transmit the claim

Roster billing for Part B providers

To enable Medicare beneficiaries to participate in mass pneumococcal and influenza virus vaccination programs offered by PHCs and other individuals and entities that give vaccines to a group of beneficiaries, the simplified roster billing process was developed.
Claims will be returned as unprocessable when the updated standard roster forms (linked below) are not submitted with the modified CMS-1500 (02/12) claim form or if the roster form/CMS-1500 claim form are incomplete.
For dates of service (DOS) on and AFTER October 1, 2015: Influenza virus vaccine: CMS-1500 (02/12) example with ICD-10 codes pdf file
Submit form for either COVID-19 vaccines or monoclonal antibody (mAb) infusions. Do not combine both on the same form.
COVID-19 vaccines -- For DOS on and AFTER December 11, 2020: COVID-19 vaccine: CMS-1500 (02/12) example with ICD-10 codes pdf file
Monoclonal antibody infusions -- For DOS on and AFTER November 10, 2020: Monoclonal antibody infusion: CMS-1500 (02/12) example with ICD-10 codes pdf file

Additional resources for mass immunizers

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.