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 only applies to COVID-19 vaccines, monoclonal antibody (mAb) infusions, influenza, pneumococcal, and hepatitis B 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 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
- Only one date of service per 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.
- Influenza virus vaccine: Roster sheet
- For dates of service (DOS) on and AFTER October 1, 2015: Influenza virus vaccine: CMS-1500 (02/12) example with ICD-10 codes
- For dates of service (DOS) on and AFTER October 1, 2015: Influenza virus vaccine: CMS-1500 (02/12) example with ICD-10 codes
- Pneumococcal pneumonia virus vaccine: Roster sheet
- For DOS on and AFTER October 1, 2015: Pneumococcal pneumonia 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
- COVID-19 Vaccines or Monoclonal Antibody Infusion Roster form
- 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
- Monoclonal antibody infusions -- For DOS on and AFTER November 10, 2020: Monoclonal antibody infusion: CMS-1500 (02/12) example with ICD-10 codes
- Submit form for either COVID-19 vaccines or monoclonal antibody (mAb) infusions. Do not combine both on the same form.
- Hepatitis B vaccine roster
Additional resources for mass immunizers
- Immunization and Vaccine Resources
- Vaccine Pricing
- Influenza Vaccine payment Allowances -- Annual update for 2023-2024 Season
- Influenza Vaccine Payment Allowances -- Annual Update for 2022-2023 Season
- Fee schedule for administration of influenza and pneumococcal virus vaccines
- Roster billing for mass immunizers webpage
- Medicare billing for COVID-19 vaccine shot administration
- COVID-19 Monoclonal Antibodies
- Medicare enrollment for mass immunizers
- Pneumococcal and influenza virus vaccine administration
- Search MLN Matters Articles for Medicare-covered Preventive Services
- Medicare Benefit Policy Manual, chapter 15, section 50.4.4.2
- Medicare Claims Processing Manual, chapter 18, section 10.3
- Medicare Program Integrity Manual, chapter 15, section 15.4.6.2