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Immunization Roster Billing

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Immunization Roster Billing

Roster billing simplifies the  process for you to submit claims for flu, pneumococcal and COVID-19 vaccines for Medicare beneficiaries.

  • Administer the same vaccine to at least five individuals on the same service date.
  • Do not mix vaccine codes (flu, pneumococcal,COVID-19, Hepatitis B) on a single roster bill; each type requires its own bill, even on the same service date.
  • Mass immunizers must use roster billing for these vaccines.
  • Do not include beneficiaries with a primary insurer other than Medicare on roster bills.

*Hepatitis B vaccine is allowed on roster bills effective with dates of service on or after 1/1/025 for claims received on or after 7/7/2025.

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Claim Submission Options for Roster Billing

Electronic Claim Submissions

  • Use PC-ACE billing software to submit directly to your MAC. Download this free billing software from your MAC and electronically submit professional claim roster billing.
  • Utilize your current claim submission software and Network Service Vendor.

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Paper Claim Submissions

A properly submitted paper roster bill includes the following documents:

  1. Complete the Health Insurance Claim Form as a coversheet.
    • Complete the following required fields of the CMS-1500:
      • 1 Place an “x” in the Medicare block
      • 2 “See Attached Roster” (This is the patient’s name field)
      • 11 Enter the word “NONE”
      • 20 Place an “X” in the No block
      • 21 Line 1: Enter the appropriate diagnosis code
        • Note: See Vaccine Billing and Coding resources below
      • 24B Line 1 and Line 2 = 60 (This is the Place of Service)
      • 24D Line 1 = Influenza, pneumococcal, COVID-19 or hepatitis B vaccine procedure code
        • Line 2 = Influenza, pneumococcal, COVID-19 or hepatitis B administration code
          • Note: See Vaccine Billing and Coding resources below
      • 24e Lines 1 and 2 = A (This is the diagnosis pointer)
      • 24f Enter the charge for each listed service
        • If there is no charge for the vaccine or its administration enter 0.00 or “NC” (no charge) on the appropriate line for that item
        • If your system is unable to accept a line item charge of 0.00 for an immunization service, do not key the line item
      • 27 Place an “X” in the YES block
      • 29 Enter “0.00”
      • 31 The provider must sign the modified CMS-1500 form
  2. Utilize the National Government Services Vaccine Roster Form available on our Forms page.

    Note: if you choose not to use the NGS Vaccine Roster Form and utilize a different form or spreadsheet, please make sure to include this information on the form. Failure to include this information will result in your claim being returned as unprocessable.
    • Patients name, address, Medicare number, date of birth and gender
    • Date of service
    • Beneficiary signature or stamped “Signature on File”
    • All patients have the same service
    • Not used for single patient billing
    • Providers name and identification number
    • Control number for contractor

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Vaccine Billing and Coding Resources

Revised 3/6/2025