This video will provide you with an overview of payment and billing for the flu shot.
We'll also review the roster billing requirements that you must follow when submitting claims
to Medicare for the flu shot.
Medicare provides coverage of the flu shot without any out-of-pocket costs to the patient.
No Part B deductible or copayment applies. We reimburse health care providers for flu
shots and their administration.
Each year, we update the Medicare Healthcare Common Procedure Coding System (HCPCS) and
Current Procedure Terminology (CPT) codes, and payment rates for flu shots.
To view the payment rates, visit cms.gov/flu-provider and click Get flu shot payment rates .
As a provider, you may bill Medicare for the administration of the flu shot. Follow normal
claims filing procedures by submitting a Health Insurance Claim Form or electronic bill for
each patient. To ease the administrative burden on your staff, consider submitting a roster bill.
You can find the Health Insurance Claim Form by using the search on cms.gov. When it comes
to roster bills, some Medicare Administrative Contractors (MACs) let you develop your own
roster forms, but others don't. Contact your MAC to learn about their roster form practices.
To find your MAC visit http://go.cms.gov/MAC-website-list.
Be sure to search for your MAC on the name list if you're submitting claims that aren't
based on your place of business.
Now that we covered the ways you can submit a claim for the flu shot, you may be wondering
what roster billing is as the billing process differs from the normal claims filing process
you may be used to.
Roster billing allows you to submit one claim for all of the patients that get flu shots
on a given day. You may submit roster bills for pneumococcal shots as well. We often refer
to providers who utilize roster billing as mass immunizers. This billing process increases
patient's access to these shots.
A mass immunizer is able to give these shots to a group of people and submit claims for
these shots on roster bills. This applies to both, flu and pneumococcal shots. A mass
immunizer may be a traditional Medicare provider or supplier, such as a hospital outpatient
department, or it may be a nontraditional provider or supplier, such as a senior citizen s center,
a public health clinic, community pharmacy or supermarket.
The way you become a Mass Immunization Roster Biller depends on whether you're an individual
provider or part of a group. To enroll in the Medicare Program solely as a Mass Immunization
Roster Biller, individuals must complete the Medicare Enrollment Application - Physicians
and Non-Physician Practitioners Form and groups must complete the Medicare Enrollment Application
- Clinics/Group Practices and Certain Other Suppliers Form. New providers must complete
the National Provider Identifier Application before they can enroll.
If you're enrolled as a Mass Immunizer Roster Biller, there are four requirements you must
meet in order to submit roster bills to Medicare for the flu shot.
First, you must have your license in the states where you operate.
Second, accept assignment on the shots and their administration. This means that you
accept Medicare payment as payment in full. You can't collect a deductible, copayment,
or coinsurance on these services.
Third, submit a a roster bill that only includes claims for flu shots.
And fourth, bill only flu shots and administration using this process.
If you meet the four requirements that we just talked about, then you can submit a roster
bill for the flu shot. You'll need to submit a modified Health Insurance Claim Form and
roster bill for patients. If you provided other services, submit claims using the normal
billing procedures.
Now, you may be wondering what happens if you're not a mass immunizer? Can you submit
a roster bill? The answer is yes. You do not have to enroll as a mass immunizer to
submit roster bills. If you currently submit Medicare Part B claims to MACs, you qualify
to submit roster bills for flu shots.
If you're not a mass immunizer and you're submitting a roster bill, the process is the
same as if you were a mass immunizer with two extra details. First, don't submit single
patient claims when you submit a roster bill. Next, if you give the flu shot to less than
five people in one day, indicate the individual date of service on the roster form for each
patient.
We hope this billing overview helps you as you submit claims for the flu shot. If you
have additional questions regarding Medicare and the flu shot visit our flu webpage at
cms.gov/flu-providers.
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to grant rights or impose obligations. This educational product may contain references
or links to statutes, regulations, or other policy materials. The information provided
is only intended to be a general summary. It is not intended to take the place of either
the written law or regulations. We encourage readers to review the specific statutes, regulations,
and other interpretive materials for a full and accurate statement of their contents.
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