Roster Billing

Roster Billing is a simplified billing process that allows mass immunizers to submit one claim with a list of the members they immunized. Mass immunizers must meet Original Medicare requirements in order to use the roster billing method.

Mass immunizers

A mass immunizer is defined as any entity that gives the influenza virus vaccine or pneumococcal vaccine to a group of beneficiaries. A mass immunizer may be a traditional Medicare provider or supplier or a nontraditional one (such as a senior citizen’s center, a public health clinic, shopping malls, grocery stores, or community pharmacy).

To qualify for roster billing immunizers must enroll in the Medicare program even if immunizations are the only service they provide and immunizations of at least five beneficiaries on the same date are required.

Roster Claim filing procedure

The simplified (roster) claims filing procedure applies to providers other than RHCs and FQHCs that conduct mass immunizations. Since independent and provider based RHCs and FQHCs do not submit individual Form CMS-1450 for the influenza virus vaccine, they do not utilize the simplified billing process. Instead, payment is made for the vaccine at the time of cost settlement.

The simplified process involves use of the provider billing form (Form CMS-1450) with preprinted standardized information relative to the provider and the benefit. Mass immunizers attach a standard roster to a single pre-printed Form CMS-1450 that contains the variable claims information regarding the service provider and individual beneficiaries.

Qualifying individuals and entities must attach a roster, which contains the variable claims information regarding the supplier of the service and individual beneficiaries.

Place of service for Roster billing

State or Local Public Health Clinic must use POS code 71 (Public Health Clinic).

POS 71 is not used for individual offices / entities other than PHCs (e.g., a mobile unit that is non-PHC affiliated should use POS 99).

Preprinted Form CMS-1500 (08-05) used for simplified roster billing should show POS 60 (Mass Immunization Center) regardless of the site where vaccines are given (e.g., a PHC or physician’s office that roster claims should use POS 60).

Individuals/entities administering influenza virus and pneumococcal vaccinations in a mass immunization setting (including centralized flu billers), regardless of the site where vaccines are given, should use POS 60 for roster claims, paper claims, and electronically filed claims.

Providers use POS 99 (Other Unlisted Facility) if no other POS code applies.

References:

https://www.cms.gov/manuals/downloads/clm104c18.pdf

https://www.cms.gov/PlaceofServiceCodes/Downloads/posdatabase110509.pdf