How Do I Bill for Administering COVID-19 Vaccines?
- You must be a Medicare-enrolled provider to bill Medicare for administering COVID-19 vaccines to Medicare patients. Learn more about Enrollment for Administering COVID-19 Vaccines.
- You can bill on single claims for administering the COVID-19 vaccine, or submit claims on a roster bill for multiple patients at a time.
- When you choose the Place of Service (POS) code for your Part B claims, carefully consider where you provided the vaccine. Roster billers should use POS code 60 regardless of your provider type, even if you’re not a mass immunization roster biller (provider specialty type 73).
- When the government provides COVID-19 vaccines at no cost, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free.
- You must administer the vaccine with no out-of-pocket cost to your patients for the vaccine or administration of the vaccine.
- If you want to administer the vaccine for free, you don’t have to submit a claim to Medicare, Medicaid, or another insurer. But, you can’t charge your patients or ask them to submit a claim to Medicare or another insurer.
- If you get government funding to help pay for administering the COVID-19 vaccine (like a federal or state grant), you can still submit a claim to Medicare for administering the vaccine.
- If you have temporary billing privileges because of the public health emergency (PHE) and you have 1 National Provider Identifier (NPI) tied to multiple Provider Transaction Access Numbers (PTANs), use the taxonomy code on your claim to help you assign the correct PTAN.
- Use the ICD-10 diagnosis code Z23 (encounter for immunization) on the claim.
- Until the PHE ends, you should include modifier CR on your claim only if you administer the COVID-19 vaccine at a temporary location that isn’t considered your actual practice location.
Is this going out on a UB? If so:
How to Submit Institutional Claims
You may use roster billing format, or submit individual claims. CMS systems will accept roster bills for 1 or more patients that get the same type of shot on the same date of service.
What Are Valid Types of Bills for Roster Billing?
- 12X, Hospital Inpatient**
- 13X, Hospital Outpatient**
- 22X, Skilled Nursing Facility (SNF)-covered Part A stay (paid under Part B) & 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 vaccines separately from the Diagnosis-Related Group (DRG) rate and doesn't allow billing them on 11X.
***If you’re a Medicare Advantage Plan provider, include Condition Code (CC) 78.