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Roster billing for Part A

Institutional providers can use roster billing when administering the influenza, pneumococcal, or COVID-19 vaccines, or monoclonal antibody infusions to at least five patients on the same date, unless the institution is an inpatient hospital. Individual claims may also be submitted. Roster bills can be submitted electronically using Direct Data Entry (DDE)/Fiscal Intermediary Shared System (FISS) or on paper using the CMS-1450 (UB-04) claim form. Submit a separate roster for each type of vaccine. Do not bill for other services on the same claim. Do not use the roster bill for a single beneficiary. 

The following are valid types of bills (TOBs) for roster billing:

  • 12X, Hospital inpatient**
  • 13X, Hospital outpatient**
  • 22X, Skilled nursing facility (SNF) covered Part A stay (paid under Part B) and inpatient Part B
  • 23X, SNF outpatient
  • 34X, Home health (Part B Only)
  • 72X, Independent and hospital-based renal dialysis facility
  • 75X, Comprehensive outpatient rehabilitation facility
  • 81X, Hospice (non-hospital)
  • 82X, Hospice (hospital)
  • 85X, Critical access hospital

** For hospitalized patients, Medicare pays for these vaccines separately from the diagnosis-related group (DRG) rate and disallows billing them on 11X.

DDE/FISS roster billing

Part A providers who use DDE/FISS can submit roster bills by following the steps below:

  • From the Main Menu in FISS, select Option 02 - Claims Entry.
  • Select Option 87 - Roster Bill Entry.
  • Report a maximum of 10 patients per page via this DDE roster page. 
    • Only one date of service per roster page.
    • Providers will press F9 to submit the claim.

Provide the following information below on the roster bill screen: 

  • Date of service 
  • Type of bill 
  • NPI 
  • Fac. zip (facility ZIP code)
  • Revenue code, HCPCS, charges per beneficiary 
  • MID number (MBI number), last name, first name, middle initial 
  • Birth date 
  • Sex 
  • Admission date 
  • Admission type 
  • Admission diagnosis 
  • Patient status code 
  • Admission source code 

FISS roster bill

CMS-1450 (UB-04) roster billing

A roster list must include the minimum requirements listed above for the roster bill screen.

For inpatient Part B services (TOB 12X and 22X) the following data elements are required in addition to the minimum requirements: 

  • Admission date 
  • Admission type 
  • Admission diagnosis 

Provider will attach a pre-printed UB-04 form to the roster list.

Include the following on the UB-04 form: 

Type of bill Based on the provider type billing
Patient name 'See attached roster'
Patient status

01- Used on outpatient claims only

Inpatient claims- use appropriate status code
Condition code M1 and A6 
Revenue code

0636 for the vaccine, with appropriate HCPCS code (if applicable based provider type)

Line 1: Appropriate COVID-19 vaccination, monoclonal antibody infusion or the influenza or pneumococcal vaccination code.

Note: If the healthcare professional receives the product free of charge, do not include on the roster bill.
Revenue code

0771 for the administration, with appropriate HCPCS code (if applicable based on provider type)

Line 2: COVID-19, monoclonal antibody infusion, influenza, or pneumococcal administration code.
Total charges

Charged amount

If not charging enter 0.00
Payer - Line A Medicare
Provider Number- Line A 'See attached roster'
Principal diagnosis code

For vaccine billing:

  • Enter Z23

For mAb billing:

  • Enter appropriate diagnosis coded to highest level of specificity (U071 – use as appropriate)
Attending physician Requires the first and last name and NPI

 

References