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Immunization Roster Billing

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Immunization Roster Billing

Roster billing is a streamlined process for you to submit claims for flu, pneumococcal and COVID-19 vaccines for Medicare beneficiaries.

  • You must administer the same type of vaccine to five or more people on the same date of service.
  • You cannot combine flu, pneumococcal and COVID-19 vaccine codes on the same roster bill.
    • You must bill each type of shot on a separate roster bill.
  • If you are enrolled as a mass immunizer, you must use roster billing.
  • MSP Claims need to be submitted individually.

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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 or COVID-19 vaccine procedure code
        • Line 2 = Influenza, pneumococcal, or COVID-19 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

Reviewed 8/28/2024