Last Modified: 4/14/2022
Location: FL, PR, USVI
Business: Part A, Part B
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.
• 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
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.
• Submit form for either COVID-19 vaccines or monoclonal antibody (mAb) infusions. Do not combine both on the same form.
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.
can submit roster bills by following the steps below:
