Roster Billing for Mass Influenza and Pneumococcal Pneumonia Vaccines
Roster billing is a quick and convenient way to bill for flu and pneumonia vaccinations. To submit a roster bill, the same type of vaccination must be provided to five or more people on the same date of service. Each type of vaccination must be billed on a separate roster bill. You cannot have pneumococcal pneumonia vaccines (PPVs) and flu vaccines on the same roster bill.
Hospice providers may submit roster bills for vaccines with dates of service on or after October 1, 2016. Vaccines may be covered when furnished by a hospice to those beneficiaries who request them, including those who have elected the hospice benefit.
Influenza or pneumococcal pneumonia immunization claims can be submitted individually if you are unable to submit a roster bill. See the Billing Individual Influenza and Pneumococcal Pneumonia Vaccines Web page for more information on submitting individual immunization claims.
To submit a roster bill via direct data entry (DDE), use the Fiscal Intermediary Standard System (FISS) 'Roster Bill Entry' Option 87 from the Claims Entry Menu. Additional information about the FISS Roster Bill Claims Entry Option 87 is available in Chapter Four — Claims and Attachments Menuof the Fiscal Intermediary Standard System (FISS) Guide.
Enter the following coding information when roster billing flu and pneumonia vaccines.
DATE OF SERV |
Enter the date the vaccine was provided (MMDDYY). |
TYPE-OF-BILL |
Only key the first 2 digits of the type of bill |
NPI |
Enter your facilities national provider identifier (NPI) |
FAC.ZIP |
Enter your facility zip code. |
REVENUE CODE |
0636 for the vaccine |
HCPCS |
For a complete list of HCPCS codes for the Influenza Virus Vaccine and Pneumococcal Pneumonia Vaccine, refer to the Medicare Claims Processing Manual (Pub. 100-04), Chapter 18, §10.2.1. NOTE: HCPCS code 90471 and 90472 should not be used to bill the administration of the influenza virus vaccine or the pneumococcal pneumonia vaccine. These codes are only used by hospitals billing for the administration of the hepatitis B vaccine. |
CHARGES PER BENEFICIARY |
Enter the charge for each revenue code |
ADMIT TYPE |
Note: In order to access the ADMIT TYPE field in the FISS roster bill screen, you will need to press the Enter key after keying the first beneficiary's Medicare ID number, Last Name, First Name, Birth Date, and Sex code information. After you press ENTER, FISS will allow access to the ADMIT TYPE field for that first beneficiary, and any additional beneficiary information that needs to be entered. 1 — Emergency |
In addition, you will need to enter the following patient information for each beneficiary.
- Medicare ID number
- Beneficiary's name (first and last)
- Beneficiary's date of birth
- Beneficiary's sex (gender)
Additional Resources
- Centers for Medicare & Medicaid Flu Shot Resources
- Flu Vaccine Partner Toolkit
- Increasing Flu Shot Outreach & Uptake
- Medicare Learning Network (MLN) Matters® article MM11882 "Influenza Vaccine Payment Allowances – Annual Update for 2020-2021 Season"
- Medicare Learning Network (MLN) Matters® article MM11428 "Influenza Vaccine Payment Allowances – Annual Update for 2019-2020 Season"
- Roster Billing for Mass Immunizers
- Seasonal Influenza Vaccines Pricing
- Medicare Benefit Policy Manual (Pub. 100-02, Ch. 15)
- Medicare Claims Processing Manual (Pub. 100-04, Ch.18)
- Preventive Services Quick Reference Chart
- Home Health Immunization Reimbursement
Updated: 12.09.20