Last Modified: 9/14/2018 Location: FL, PR, USVI Business: Part A, Part B
Immunization roster billing
Medicare beneficiary numbers are changing in 2018
The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new Medicare Beneficiary Identifier (MBI) will replace the SSN-based Medicare number on new Medicare cards starting this year for Medicare transactions like billing, eligibility status, and claim status.
Find more details here.
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) 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.
• For dates of service (DOS) on and AFTER October 1, 2015: Influenza virus vaccine: CMS-1500 (02/12) example with ICD-10 codes
• For DOS on and AFTER October 1, 2015: Pneumococcal pneumonia virus vaccine: CMS-1500 (02/12) example with ICD-10 codes
Additional resources for mass immunizers
• Mass Immunizers and Roster Billing: Simplified Billing for Influenza Virus and Pneumococcal Vaccinations fact sheet (ICN 907275)
• Medicare Part B Immunization Billing: Seasonal Influenza Virus, Pneumococcal, and Hepatitis B Educational Tool
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