Roster Billing Guide For Influenza and Pneumonia
Contents
1. Codes 90653 Influenza vaccine inactivated subunit adjuvanted for intramuscular use 90654 Influenza virus vaccine split virus preservative free for intradermal use 90655 Influenza virus vaccine trivalent split virus preservative free when administered to children 6 35 months of age for intramuscular use 90656 Influenza virus vaccine trivalent split virus preservative free when administered to individuals 3 years and older for intramuscular use 90657 Influenza virus vaccine trivalent split virus when administered to children 6 35 months of age for intramuscular use 90660 Influenza virus vaccine trivalent live for intranasal use 90661 Influenza virus vaccine derived from cell cultures subunit preservative and antibiotic free for intramuscular use 90662 Influenza virus vaccine split virus preservative free enhanced immunogenicity via increased antigen content for intramuscular use 90669 Pneumococcal conjugate vaccine 7 valent for intramuscular use 90670 Pneumococcal conjugate vaccine 13 valent for intramuscular use 90672 Influenza virus vaccine quadrivalent live for intranasal use 90673 Vaccine for influenza administered into muscle preservative and antibiotic free 90685 Influenza virus vaccine quadrivalent split virus preservative free when administered to children 6 35 months of age for intramuscular use 90686 Influenza virus vaccine quadrivalent split virus preservative free when administered2. not be made before the 14 day after the date of receipt Reimbursement Reimbursement amounts for flu and pneumonia vaccines and their administration are updated quarterly by the Centers for Medicare amp Medicaid Services CMS To access the reimbursement amounts for flu and pneumonia vaccines go to http www cms hhs gov McrPartBDrugAvgSalesPrice 01_overview asp TopOfPage Under Medicare Part B Drug Average Sales Price listing left side of page select Seasonal Influenza Vaccines Pricing This provides current and past flu season payment allowances for the listed CPT codes and Q codes when furnished outside the hospital outpatient department 8 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Required Documentation There must be documentation to support each service billed Illegible documentation is of no value in verifying medical necessity or coding accuracy for services billed Lack of documentation could be considered fraud or abuse which is subject to monetary penalties imprisonment and or exclusion from participation in the Medicare program Patient Signature The patient or authorized representative must sign the roster unless the signature is on file The patient s signatur
3. o Special characters i e hyphens periods parentheses dollar signs and ditto marks o Do not fold your claim and roster forms o We recommend that you DO NOT fill in the Date of Service Item 24A on the CMS 1500 claim form o Use ONLY the Date of Service field on the Roster Form 12 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Please follow these helpful hints when completing the roster forms O Typed rosters are preferable the new interactive rosters have made this an easier process for you If roster information is not typed the roster information must be printed and legible Date of Service The format used for the date of service should be MM DD YYYY or MM DD YY e g 01 01 2015 or 01 01 15 You may only submit ONE Date of Service per Roster If the date of service is submitted incorrectly the service will be rejected Patient s Medicare Health Insurance Claim Number Enter the patient s complete Medicare Health Insurance Claim Number HICN as indicated on the Red White Blue Medicare card Patient s Last Name The patient s last name must be completed as indicated on the Red White Blue Medicare card Patient s First Name The patient s first name must be completed as in
4. to individuals 3 years of age and older for intramuscular use 90687 Influenza virus vaccine quadrivalent split virus when administered to children 6 35 months of age for intramuscular use 90688 Influenza virus vaccine quadrivalent split virus when administered to individuals 3 years of age and older for intramuscular use 90732 Pneumococcal polysaccharide vaccine 23 valent adult or immunosuppressed patient dosage when administered to individuals 2 years or older for subcutaneous or intramuscular use Q2034 Influenza virus vaccine split virus for intramuscular use Agriflu Q2035 Influenza virus vaccine split virus when administered to individuals 3 years of age and older for intramuscular use Afluria Q2036 Influenza virus vaccine split virus when administered to individuals 3 years of age and older for intramuscular use Flulaval Q2037 Influenza virus vaccine split virus when administered to individuals 3 years of age and older for intramuscular use Fluvirin Q2038 Influenza virus vaccine split virus when administered to individuals 3 years of age and older for intramuscular use Fluzone Q2039 Influenza virus vaccine split virus when administered to individuals 3 years of age and older for intramuscular use Not Otherwise Specified x _ _a co gt _6_om_m A 100O0R000O0O0o0u0u0qa0qao0qa0qo0 ud 41 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserv
5. NOTE Should you have landed here as a result of a search engine or other link be advised that these files contain material that is copyrighted by the American Medical Association You are forbidden to download the files unless you read agree to and abide by the provisions of the copyright statement Read the copyright statement now and you will be linked back to here Ne PALMETTO GBA A CELERIAN GROUP COMPANY Roster Billing Guide For Influenza and Pneumonia Immunizations To Medicare Part B FLU Gov semini Palmetto GBA A CMS Contracted Medicare Administrative Contractor October 2015 CMS gov Centers for Medicare amp Medicaid Services Roster Billing Guide For Influenza and Pneumonia Immunizations Index LL NTO RARO IAA E 2 EO eT E ine peste sieves E A ani 3 Cielo 4 Coding amp Remi lla 6 Required DoCuMe mation sasisiccssntesanasavenacvoscesduvencevedivanadaeansdpneradseavastansa edsasivdesaseosaaaasnstadsaesededdaatvouss 9 Roster Billing sfiora 10 Electronic Roster Billie ala 11 Claims hihi 12 Influenza and Pieumococcal Claims silla dada 14 Vaccine Administration Record HEA 3314 Form i 16 Additional Reference Maenalisania n 17 Influenza and Pneumococcal Roster FAGS 18 Forms Vaccine Administration Record HEA 3314 Form 1 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publi
6. against certain viral diseases Influenza For Dates of Service 10 1 15 amp After ICD 10 Diagnosis Code o A valid diagnosis is required on ALL influenza and pneumococcal claims o Claims submitted with an invalid or incomplete diagnosis code will be rejected and must be resubmitted with corrected information as new claims Pneumonia ICD 10 CM Code o Z23 Encounter for immunization Influenza ICD 10 CM Codes o Z23 Encounter for immunization IMPORTANT Please submit the diagnosis appropriate for the date of service submitted 7 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Important Information O Medicare will pay 100 of the allowed amount for the influenza and pneumococcal vaccines and their administration The Part B deductible and 20 coinsurance do not apply If a patient receives both the influenza and the pneumococcal vaccine on the same day Medicare will pay an administration fee for each Roster bills are considered paper claims and are not paid as quickly as claims submitted electronically The payment floor for paper claims is 28 days payment will not be made before the 29tn day after the date of receipt The payment floor for electronic claims is 13 days payment will
7. atient or authorized representative sign the roster Attach the pre printed 1500 claim form to the appropriate roster s and mail it to 14 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations State Address Part B Palmetto GBA P O Box 100190 Columbia SC 29202 3190 Railroad Palmetto GBA Railroad Medicare P O Box 10066 Augusta GA 30999 Standard CMS 1500 Claim Form versus Pre Printed CMS 1500 Claim Form When using the standard CMS 1500 claim form normal billing procedures apply and ALL required items must be completed The Pre Printed CMS 1500 Claim Form contains standardized information required for the immunization being billed If the standard CMS 1500 claim form is submitted with incomplete information the claim will be rejected Rejected claims must be resubmitted as NEW claims Only one error will be identified per claim Please double check the entire claim for accuracy and completeness before resubmitting 15 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumo
8. ation If only the administration is provided cross out the code for the vaccine o Item 24J Enter the rendering provider s NPI in the shaded portion o This field is only required if a group NPI is submitted in Block 33a o Item 31 Signature of Physician or Supplier o Enter the signature of the provider or representative and the date the form was signed o Item 32 Service Facility Location Information o Enter the name address and ZIP Code of the location where the service was provided including centralized billers o 32A Enter the NPI of the service facility o Item 33 Physician s Supplier s Billing Name Address Zip Code and Phone o Enter the billing provider s name address zip code and telephone number o 33a Enter the NPI of the billing provider or group Roster Forms o Acopy of the Roster form is available on the Palmetto GBA Web site at State Web Site Part B http www palmettogba com palmetto providers nsf DocsCat Providers JM 20Part 20B Browse 20by 20Topic Preventive 20Services Immunization 8ERPCC3 328 open amp navmenu Browse Seby SeTopiclIlI Railroad http www palmettogba com palmetto providers nsf DocsCat Providers Railroad 2 OMedicare Preventive 20Services Immunization 88EMGK7882 open amp navmenu Preventive Servicesllll o Print and complete all fields with the requested information o For patient signature indicate YES if HEA 3314 or similar form is on file or have the p
9. cation of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Introduction Palmetto GBA has prepared this packet for health care providers who mass immunize their patients against influenza and pneumonia The packet contains instructions on how to submit claims using the roster billing method Please share this information with appropriate members of your staff If you have questions regarding influenza and pneumonia immunizations contact the appropriate Medicare Part B Provider Contact Center that processes your claims State Toll Free Telephone Number Part B 1 855 696 0705 Monday Friday 8 00 a m until 4 30 p m ET Railroad 1 888 355 9165 Monday Friday 8 30 a m until 4 30 p m ET 2 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Coverage Influenza Virus Vaccine Influenza virus vaccine and its administration are covered when furnished in compliance with any applicable State law by any provider of service or any entity or individual with a provider or supplier number The patient may receive the vaccine upon request without a physician s order and without physician supervision General
10. cians and suppliers who provide covered services to Medicare patients You may not charge your patients for preparing or filing a Medicare claim The requirement to submit Medicare claims does not mean you must accept assignment Carriers monitor compliance with mandatory claims filing requirements Providers that violate these requirements may be subject to a civil monetary penalty of up to 2 000 for each violation and or Medicare program exclusion NOTE Mass immunizers are prohibited from collecting payment from patients who have traditional or original Medicare for the administration or cost of the influenza or pneumococcal vaccine 4 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Enrollment Requirements Providers and suppliers who want to mass immunize and submit claims to Medicare on roster bills must enroll in the Medicare program Providers and suppliers must enroll in Medicare even if mass immunizations are the only services they will provide to Medicare patients They can enroll by filling out a CMS 855 form the Provider Supplier Enrollment application Providers and suppliers who wish to roster bill for mass immunizations should contact the appropriate number below for a copy of the enrol
11. ct Software amp Manuals 11 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Claims Filing Information Optical Character Recognition OCR Through the use of an OCR system claim information from the pre printed CMS 1500 claim form will be entered into the processing system more rapidly Successful scanning begins with the proper submission of claim data It is important that claims be submitted with proper and legible coding Claims that are not legible or properly coded may be returned or rejected Please follow these helpful hints when completing your pre printed CMS 1500 forms The font should be o Legible computerized or typed claims laser printers are recommended o In Black Ink o Courier Arial 10 11 or 12 font type o CAPITAL letters The font must NOT have o Dot matrix font o Bold Script Italic or Stylized font o Broken characters o Red Ink o Mini font Do NOT submit with o Liquid correction fluid changes o Data touching box edges or running outside of numbered boxes o Narrative descriptions of procedure narrative description of modifier or narrative description of diagnosis o Stickers or rubber stamps o Data or labels on the top portion of the pre printed CMS 1500 claim form
12. dicated on the Red White Blue Medicare card Patient s Middle Initial The patient s middle initial must be completed as indicated on the Red White Blue Medicare card Patient s Address The patient s address field must be complete for each patient Drawing a line through the patient s address field is not acceptable If the patient s address is submitted incorrectly the service will be rejected Patient s Signature The patient s signature field must be complete for each patient Submitting the patient s signature on the first line of the roster and drawing a line through the remaining patient s signature fields is not acceptable If the patient s signature is submitted incorrectly the service will be rejected 13 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Influenza and Pneumococcal Claims Pre Printed CMS 1500 Claim Form 02 12 Requirements The following information must be submitted in addition to the information pre printed on the CMS 1500 claim form included in this packet o Item 24F Charges o Enter the charge for a single influenza or pneumococcal vaccine If only the vaccine is given cross out the code for the administration o Enter the charge for a single administr
13. e Servicesllll e DO NOT SUBMIT flu services on the pneumococcal roster o This will result in a delay in the processing of your claims e DO NOT SUBMIT pneumococcal services on the flu roster o This will result in a delay in the processing of your claims e Enter the appropriate CPT HCPCS code s for the vaccine used when completing the pre printed CMS 1500 claim form e A maximum of ten 10 rosters may be attached to a single pre printed CMS 1500 claim form e The pre printed CMS 1500 claim forms serve as cover documents for the rosters o The claim forms and the rosters may be duplicated for future claims submission 10 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Electronic Roster Billing A PC ACE Pro32 Software User s Manual has been created to provide you with information on Medicare s courtesy software PC ACE Pro32 which allows for electronic roster billing Medicare provides the software and technical support free of charge For more information or to view the packet please visit our Web site at State Web Site Part B e Goto http www PalmettoGBA com jmb edi e On the left select Software amp Manuals Railroad e Goto http www PalmettoGBA com rr edi e On the left sele
14. e authorizes release of medical information necessary to process the claim It also authorizes payment of benefits to the provider when the provider accepts assignment on the claim In lieu of signing the roster a patient may sign a form that is retained in the provider s file and is available for audit by the Medicare carrier The HEA 3314 form was designed by the Centers for Disease Control and Prevention and modified for use with roster bills A completed form meets Medicare s documentation and signature requirements For your convenience a copy is included in this packet and may be duplicated as needed If the patient is physically or mentally unable to sign a representative may sign on the patient s behalf In this event the signature line on the statement must indicate the patient s name followed by the representative s name address relationship to the patient and the reason the patient cannot sign When a physically handicapped patient signs by mark i e X a witness must enter his her name and address next to the mark 9 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Roster Billing Instructions The Social Security Act Section 1848 g 4 A requires that providers bill Medicar
15. e for covered Part B services rendered to eligible Medicare patients This includes mass immunizers who provide influenza and pneumococcal vaccines and their administration to Medicare patients Roster billing is a simplified process used by mass immunizers Two requirements must be met in order to use this simplified process 1 The only services that may be billed on a roster are the vaccine and or administration and 2 The provider agrees to accept assignment i e agrees to accept Medicare payment as payment in full for influenza and pneumococcal vaccine claims Providers who do not accept assignment must complete the standard CMS 1500 claim form or submit claims electronically for each Medicare patient receiving the vaccines Mass immunizers MUST accept assignment e A copy of the Pre Printed CMS 1500 claim form for the influenza and pneumococcal immunizations are included at the end of this packet e A copy of the Pre Printed CMS 1500 claim form for the influenza and pneumococcal immunizations are available on the Palmetto GBA Web site at State Web Site Part B http www palmettogba com palmetto providers nsf DocsCat Providers JM 20Part 20B Browse 20by 20Topic Preventive 20Services Immunization 8ERPCC3 328 open amp navmenu BrowseXby TopiclIll Railroad http www palmettogba com palmetto providers nsf DocsCat Providers Railroad 2 OMedicare Preventive 20Services Immunization 88EMGK7882 open amp navmenu Preventiv
16. ed or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Admin Codes Description G0008 Administration of influenza virus vaccine G0009 Administration of pneumococcal vaccine NOTE 02039 is a Not Otherwise Specified code for the flu vaccine It is to be used when a flu vaccine is administered but the specific vaccine has not been assigned a CPT HCPCS code and no other code description covers the vaccine being administered In order to identify the specific flu vaccine administered along with the cost associated with the vaccine Palmetto requires an invoice to be submitted when Q2039 is billed Also any vaccines which have not had a price established by CMS or by Palmetto GBA may require an invoice For Dates of Service 9 30 15 amp Prior ICD 9 Diagnosis Codes o A valid diagnosis is required on ALL influenza and pneumococcal claims o All diagnosis codes must be reported at the highest level of specificity o Claims submitted with an invalid or incomplete diagnosis code will be rejected and must be resubmitted with corrected information as new claims Pneumonia ICD 9 CM Code o V03 82 Other specified vaccinations against single bacterial diseases streptococcus pneumoniae pneumococcus Influenza ICD 9 CM Codes o V04 81 Need for prophylactic vaccination and inoculation
17. lment application and special instructions for mass immunizers State Toll Free Telephone Number Part B 1 855 696 0705 Monday Friday 8 00 a m until 4 30 p m ET Railroad 1 888 355 9165 Monday Friday 8 30 a m until 4 30 p m ET Providers and suppliers who do not provide other covered services to Medicare patients need only to complete the portion of the enrollment form that applies to mass immunizers e For more information please visit one of the following Web sites e CMS Internet Only Manual IOM Medicare Claims Processing Manual Publication 100 04 Chapter 18 Section 10 e Information on the appropriate procedure code to use for the influenza and pneumococcal vaccines e Information regarding reimbursement for the influenza and pneumococcal vaccines e CMS Immunizations Quick Reference Guide http www cms hhs gov MLNProducts downloads qr_immun_bill pdf 5 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Coding amp Reimbursement The following codes must be used appropriately when submitting claims for influenza and pneumococcal vaccines and their administration CPT HCPCS Description
18. ly one influenza vaccination is allowed per flu season Pneumococcal Vaccine Dates of Service on and Prior to September 18 2014 Medicare Part B program covered pneumococcal pneumonia vaccine and its administration when furnished in compliance with any applicable State law by any provider of services or any entity or individual with a supplier number Coverage included an initial vaccine administered only to persons at high risk of serious pneumococcal disease with revaccination administered only to persons at highest risk of serious pneumococcal infection and those likely to have a rapid decline in pneumococcal antibody levels provided that at least 5 years had passed since the previous dose of pneumococcal vaccine Patients at high risk included e All people age 65 and older e Immunocompetent adults who are at high risk of pneumococcal disease or its complications because of chronic illness e g cardiovascular disease pulmonary disease diabetes mellitus alcoholism cirrhosis or cerebrospinal fluid leaks and e Individuals with compromised immune systems e g splenic dysfunction or anatomic asplenia Hodgkin s disease lymphoma multiple myeloma chronic renal failure HIV infection nephritic syndrome sickle cell disease or organ transplantation Effective for Dates of Service on and After September 19 2014 The Advisory Committee on Immunization Practices ACIP updated its guidelines regarding pneumococcal vaccines now
19. ndividuals and entities that give the vaccine to a group of beneficiaries Generally providers will qualify to use the simplified process if they o Bill Medicare for flu and or pneumonia vaccines for multiple beneficiaries o Agree to accept assignment for influenza and or pneumonia vaccination claims When a provider accepts assignment he may not collect any money from the beneficiary for the vaccination Note Only the CMS approved paper simplified forms as shown in this publication will be accepted for claims processing All other forms will be returned What is a mass immunizer CMS defines mass immunizer in the following manner o A mass immunizer generally offers flu and or pneumonia PPV vaccinations to a large number of individuals the general public or members of a specific group such as residents of a retirement community o A mass immunizer may be a traditional Medicare provider or supplier such as a hospital outpatient department or may be a nontraditional provider or supplier such as a senior citizen s center a public health clinic community pharmacy or supermarket o A mass immunizer submits claims for immunizations on roster bills o Mass immunizers MUST accept assignment Mandatory Claims Filing Requirements Section 1848 g 4 of the Social Security Act REQUIRES that you submit claims for all your Medicare patients for services rendered on or after September 1 1990 This requirement applies to all physi
20. nia Immunizations Vaccine Administration Record HEA 3314 Form The doctor or clinic may keep this record in your medical file or your child s medical file They will record what vaccine was given when the vaccine was given the name of the company that made the vaccine the vaccine s special lot number the signature and title of the person who gave the vaccine and the address where the vaccine was given T have read or have had explained to me the information in this pamphlet about influenza and or pneumococcal disease and the influenza and or pneumococcal vaccine I have had a chance to ask questions that were answered to my satisfaction I believe I understand the benefits and risks of influenza and or pneumococcal vaccine s and ask that the vaccine s be given to me or the person named below for whom I am authorized to make this request Information about the person to receive the vaccine s Please print Name Last First MI Date of Birth Age Address Street City County State Zip Signature of person to receive vaccine or person authorized to make the request parent or guardian x Date For Medicare Recipients I authorize the release of any medical or other information necessary to process this claim I also request payment of government benefits either to myself or to the party who accepts assignment Medicare Beneficiary Claim Number HIC FOR CLINIC OFFICE USE Clinic Office Addres
21. other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Influenza and Pneumococcal Roster FAQs Dolhaveto submit a separate CMS 1500 02 12 Claim Form for each beneficiary I vaccinated o No To submit claims for mass immunizations you may submit one CMS 1500 02 12 Claim Form and a completed roster form More than one roster form may be submitted with one CMS 1500 02 12 Claim Form however the date of service must be clearly indicated How do I indicate which patients on the roster I am billing for Medicare reimbursement o Beneficiaries that do not need Medicare reimbursement must be crossed off the roster A black marker should be used to cross off the entire line of the affected non Medicare vaccine recipient How do I ensure that the information entered on the roster by the patients is correct o Following the instructions on pages 11 thru 15 the roster must have the beneficiary s name first and last address gender Medicare Health Insurance Claim HIC number date of birth and the beneficiary s signature The beneficiary s name and Medicare HIC number must be submitted as it appears on the beneficiary s Medicare card This information must be legible in order for the claims examiner to process the roster correctly Illegible information may not be processed correctly and will result in incorrect o
22. r delayed reimbursement Can I submit handwritten rosters o While handwriting is discouraged it is acceptable The information that is submitted must be legible Information should be printed clearly in black ink In order to ensure fast and accurate processing providers are strongly encouraged to submit typed or computer generated rosters How do I indicate the beneficiary s signature on the roster form o The beneficiary s signature may be indicated a single stamp on the top or bottom of the roster is NOT acceptable The actual signature or the signature indicator must be legible 18 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015
23. recommending the administration of two different pneumococcal vaccinations Medicare Part B program will now cover An initial pneumococcal vaccine to all Medicare beneficiaries who have never received the vaccine under Medicare Part B and A different second pneumococcal vaccine one year after the first vaccine was administered that is 11 full months have passed following the month in which the last pneumococcal vaccine was administered Since the updated ACIP recommendations are specific to vaccine type and sequence of vaccination prior pneumococcal vaccination history should be taken into consideration Receiving multiple vaccinations of the same vaccine type is not generally recommended Medicare does not require a doctor of medicine or osteopathy to order the vaccine therefore the beneficiary may receive the vaccine upon request without a physician s order and without physician supervision 3 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations General Information Simplified Billing for Influenza and Pneumonia Vaccinations The simplified roster billing process was developed to enable Medicare beneficiaries to participate in mass pneumococcal and influenza virus vaccination programs offered by i
24. s Clinic Office MEDICARE NPI INFLUENZA PNEUMOCOCCAL Date Vaccine Administered Vaccine Manufacturer Vaccine Lot Number Site of Injection Signature of Vaccine Administrator Title of Vaccine Administrator HEA 3314 Rev 5 98 12 16 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such other date of publication of CPT All Rights Reserved Applicable FARS DFARS apply Version 12 October 2015 Roster Billing Guide For Influenza and Pneumonia Immunizations Additional Reference Material o Know What to Do About the Flu http www flu gov index html o CMS Website Adult Immunizations http www cms hhs gov AdultImmunizations o The CDC Website Seasonal Influenza Flu http www cde gov flu o The CDC Website Seasonal Influenza Flu Basics http www cdc gov flu about disease index htm o American Lung Association Website Flu http www lungusa org lung disease influenza o The CDC Website Pneumonia Can Be Prevented Vaccines Can Help http www cdc gov Features Pneumonia o The CDC Website Pneumococcal Vaccination http www cdc gov vaccines vpd vac pneumo default htm o American Lung Association Website Pneumonia http www lungusa org lung disease pneumonia 17 CPT codes and descriptions only are copyright 2008 American Medical Association All Rights Reserved or such
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