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Last Modified: 6/16/2017 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 does apply to 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 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
• 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.
• Influenza virus vaccine: Roster sheet pdf file
• 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
• Pneumococcal pneumonia virus vaccine: Roster sheet pdf file
• For DOS on and AFTER October 1, 2015: Pneumococcal pneumonia virus vaccine: CMS-1500 (02/12) example with ICD-10 codes pdf file

Additional resources for mass immunizers

• Medicare enrollment for mass immunizers
• Qualification requirements for mass immunization roster billers
• Allowance for influenza and pneumococcal virus vaccine administration
• Mass Immunizers and Roster Billing: Simplified Billing for Influenza Virus and Pneumococcal Vaccinations fact sheet (ICN 907275) external pdf file
• Pneumococcal and influenza virus vaccine administration frequently-asked question (FAQ)
• Adult Immunization Resources for Providers external link
• Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B Educational Tool external pdf file
• Seasonal influenza vaccines pricing external link
• Medicare Benefit Policy Manual, chapter 15, section 50.4.4.2 external pdf file
• Medicare Claims Processing Manual, chapter 18, section 10.3 external pdf file
• Medicare Program Integrity Manual, chapter 15, section 15.4.6.2 external pdf file
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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.