Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody

Table of Contents

• Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody
• Roster Billing
• How to Submit a Centralized Bill
• Medicare Advantage Plan Enrolled Beneficiaries
• How to Submit Institutional claims
  • Electronic Claims
• How to Submit Part B Professional Claims
  • Electronic Claims Options
  • Paper Claims
• COVID-19 Vaccines and Administration
• Monoclonal Antibodies and Administration
• Provider Eligibility

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Medicare Part A and B Billing for the COVID-19 Vaccine and Monoclonal Antibody

With the end of the PHE, as of 5/11/2023, this information no longer applies. We will keep the information available for PHE-related services that occurred prior to the expiration date that have not yet been billed.

Medicare providers may bill immunizations, including COVID-19 vaccine administration, as a single claim per patient or on a roster bill for multiple patients.

COVID-19 vaccine and monoclonal antibody doses provided by the government, without charge, cannot be billed on Medicare claims. Only include the vaccine administration code on the claim when the vaccines are free

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Roster Billing

If you use roster billing, you must administer the same type of shot to five or more people on the same date of service.

The Vaccine Roster Form must include the following details, and must include a modified CMS-1500 claim form or CMS-1450 claim form; as a roster cover document for each facility where the services are rendered:

• Patients name, address, Medicare number, date of birth and gender
• Date of service
• Beneficiary signature or stamped “Signature on File”
• Providers name and identification number
• Control number for contractor

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How to Submit a Centralized Bill

Centralized billing allows mass immunizers to send all roster bill claims for flu, pneumococcal, and COVID-19 vaccinations to a single MAC, Novitas, for payment, regardless of where you administer the shots.

Medicare makes geographic payment adjustments based on the locality where you administer the shot. You must submit all centralized biller claims as professional claims on a roster bill.

• You must operate in at least three MAC Jurisdictions.
• You can refer to the Who are the MACs web page on the CMS website.

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Medicare Advantage Plan Enrolled Beneficiaries

For claims with dates of service on or after 1/1/2022, please submit COVID vaccination claims to the Medicare Advantage (MA) plan that your patient is enrolled with.

For claims with dates of service in calendar years 2020 and 2021, the COVID vaccination claim is submitted to your A/B MAC when your patient is enrolled in a MA plan. Part A and Home Health and Hospice (HH+H) claims must include Condition Code 78.

For additional information refer to Medicare Billing for COVID-19 Vaccine Shot Administration.

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How to Submit Institutional claims

These instructions apply to individually submitted claims.

Valid Part A type of bills (TOB)

• 12X, Hospital Inpatient**
• 13X, Hospital Outpatient**
• 22X, 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 the COVID-19 shots separately, on a 12X claim, from the DRG rate and disallows billing them on 11X.

RHCs and FQHCs are paid for administrating COVID-19 vaccines at 100% of reasonable cost through the cost report.

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Electronic Claims

Use Direct Data Entry:

1. Option 02, Claims Attachment
2. Option 87, Roster Bill Entry

Paper Claims- Note: Facilities submitting claims to Part A must have a valid ASCA Waiver on file.

1. CMS-1450 (UB-04)
2. Vaccine Roster Form for patients

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How to Submit Part B Professional Claims

These instructions apply to individually submitted claims.

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Electronic Claims Options

• Utilize your current claim submission software and Network Service Vendor.
• Submit claims using our provider portal NGSConnex.
• Use PC-ACE billing software to submit directly

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Paper Claims

1. Health Insurance Claim Form (CMS-1500)
   • Required fields: Items 1, 11 and 14-33 (with the exception of 24J)
2. Vaccine Roster Form for patients

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COVID-19 Vaccines and Administration

The claim should include the proper billing of the ICD-10. Providers can submit claims using the following example:

• ICD-10: Z23 - Encounter for immunization
• Report the proper date of service
• Report the proper place of service (for Part B claims)
• Get the most current list of billing codes, payment allowances and effective dates at COVID-19 Vaccines and Monoclonal Antibodies

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Monoclonal Antibodies and Administration

The claim should include the proper billing of the ICD-10. Providers can submit claims using the following claim example:

• Primary diagnosis of U0071 as appropriate
• Report the proper date of service
• Report the proper place of service (for Part B claims)
• Get the most current list of billing codes, payment allowances, and effective dates at COVID-19 Vaccines and Monoclonal Antibodies
• View additional information about Monoclonal Antibody COVID-19 Infusion

Reminder: The CMS COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing document provides additional helpful information on COVID-19.

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Provider Eligibility

If you are enrolled in Medicare under these institutional or professional provider types, you don’t need to take any action to administer and bill the COVID-19 administration, either through individual claims or roster bill, without enrolling as a mass immunizer.

If you are not enrolled or enrolled under these professional provider type that do not allow you to bill for administering vaccines, enroll as a mass immunizer.

Reviewed 10/14/2024