DPC News

CMS.gov | Medicare Billing for COVID-19 Vaccine Shot Administration

By CMS.gov | SOURCE: CMS.gov (Click Here to Read)

How to Bill for COVID-19 Shot Administration

  • You’ll be able to bill on single claims for COVID-19 shot administration, or submit claims on a roster bill for multiple patients at one time.
  • When COVID-19 vaccine doses are provided by the government without charge, only bill for the vaccine administration. Don’t include the vaccine codes on the claim when the vaccines are free.
  • If you participate in a Medicare Advantage Plan, submit your COVID-19 claims to Original Medicare for all patients enrolled in Medicare Advantage in 2020 and 2021.

How to submit a claim if you’re a Medicare Advantage Plan contracted provider

If you are a Medicare Advantage contracted provider, submit claims for administering COVID-19 vaccines to Original Medicare through your MAC as outlined in the institutional and professional instructions below.

How to submit institutional claims

If you use roster billing for institutional claims, you must administer shots to at least 5 patients on the same date, unless the institution is an inpatient hospital.  You can also submit individual claims.

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 shots separately from the Diagnosis-Related Group rate and disallows billing them on 11X.

How to submit an institutional claim

Electronic Claims

Use Direct Data Entry:

  1. Option 02, Claims Attachment
  2. Option 87, Roster Bill Entry

Paper Claims

  1. CMS-1450 (UB-04)
  2. Roster form for patients (contact your MAC (PDF) for this form)

How to submit professional claims

If you use roster billing for professional claims, you must administer the same type of shot to 5 or more people on the same date of service. You can also submit individual claims.

How to submit a professional claim

Electronic Claims

Use PC ACE billing software to submit directly to your MAC. Download this free billing software (PDF) from your MAC and electronically submit professional claim roster billing.

Paper Claims

  1. Health Insurance Claim Form (CMS-1500) (PDF)
  2. Roster form for patients (contact your MAC (PDF) for this form)

How to submit a centralized bill

If you’re enrolled as a centralized biller, you can submit a professional claim to Novitas, regardless of where you administered the shots

Related Links

Page Last Modified:12/03/2020 01:08 PMSOURCE: https://www.cms.gov/medicare/covid-19/medicare-billing-covid-19-vaccine-shot-administration

Categories: DPC News

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