Part B Insider (Multispecialty) Coding Alert

Flu shots have become almost as popular as annual wellness visits to fend off illness, and because of that many providers and suppliers offer them en masse. Many practices and suppliers offer flu clinics now, which perform mass immunizations during each flu season. With large numbers of beneficiaries being vaccinated around the same time, CMS gives providers the option to utilize roster billing.

Background. Roster billing makes the claims process more efficient for providers who do large group influenza vaccinations annually. To apply for roster billing through Medicare – which is ongoing without no specific sign-up dates –you must be licensed in the state where you operate your practice, enroll with your A/B MAC, and submit all your bills to your local contractor, suggests NGS Medicare in a Sept. 28, 2016 fact sheet.

Remember.  If you choose to enroll, remember that you must choose the specialty type as 73 (Mass immunization roster biller) for the application to be accepted.

Don’t Mix and Match Vaccines on the Same Roster Bill

Influenza and pneumococcal immunizations are the only vaccine-types accepted through roster billing, but they cannot be claimed together. “You cannot mix vaccines on the same roster bill,” Michelle Coleman CPC, NGS provider outreach and education indicates in a Sept. 28, 2016 web presentation. “You must use separate claims and roster bills for influenza and pneumococcal or the claims will be rejected.”

Tip. It is important to note that you can still use the CMS-1500 form, but it will be filled out differently than you would for a single immunization claim with changes to the line items that are appropriate and relate to a large group claim. 

Resource: For a closer look at what roster billing entails, visit https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Mass_Immunize_Roster_Bill_factsheet_ICN907275.pdf.

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