Tools & forms: Billing / coding
Tools
Fee Schedule Lookup
MSP Calculator 
E/M Worksheet 
ESRD Calculator Forms
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.
| Form | Description | Sample form |
|---|---|---|
| Use this form to capture patient information when creating an influenza virus vaccine roster. | View influenza example | |
| Use this form to capture patient information when creating a pneumococcal pneumonia virus vaccine roster. | View pneumococcal example | |
| This roster may be used to capture patient information when creating an COVID-19 vaccine or monoclonal antibody infusion roster. | ||
| Use this form when roster billing for Hepatitis B vaccinations for dates of service on / after January 1, 2025. | N/A |