CorporateBusiness Services

Billing Individual Influenza and Pneumococcal Pneumonia Vaccines

When the same type of vaccine is administered to fewer than 5 Medicare beneficiaries on the same day, you must submit the claim(s) individually via the 'Home Health' Option 26 from the Claims Entry Menu. The influenza virus vaccine and pneumococcal pneumonia vaccination (PPV) are billed on a 341 type of bill (home health outpatient Part B benefit). The beneficiary must be eligible for Medicare Part B to receive reimbursement for these services.

Roster Billing for Mass Influenza and Pneumococcal Pneumonia Vaccines is only available when the same type of vaccination is given to five or more people on the same date of service.

In addition to the usual information that is required on Medicare claims, include the following vaccination coding requirements:

Claim Information Influenza Virus Vaccine PPV
Type of Bill (TOB) 341 — Home health outpatient (Part B)
Condition Code (COND CODES) A6 — PPV/Medicare Pneumococcal Pneumonia/Influenza 100% Payment
Revenue Code (REV) 0636 for the vaccine
0771 for the administration
HCPCS (HCPC) For a complete list of HCPCS codes for the Influenza Virus Vaccine and Pneumococcal Pneumonia Vaccine, refer tothe Medicare Claims Processing Manual (Pub. 100-04), Chapter 18, §10.2.1.External PDF
Release of Information (RI) Y — A signed statement is on file permitting release of data.
N — No release is on file.
Principal Diagnoses code (DIAGNOSIS CODES 1)
  • For services on or after October 1, 2015, ICD-10-CM diagnosis code Z23 may be used.
  • For services prior to October 1, 2015, the following ICD-9-CM diagnosis codes may be used.
V04.81 (influenza virus vaccine) V06.6 (use in place of V04.81 when giving both PPV and influenza vaccines during the same visit) V03.82 (PPV) V06.6 (use in place of V03.82 when giving both PPV and influenza vaccines)
ATT PHYS NPI When a physician's NPI is not available, the agency should submit their own NPI in this field. In addition:

  • Enter "Roster" in the 'LN' (last name) field; and
  • Enter "Bill" in the 'FN' (first name) field.
Note that with the implementation of NPI, Unique Physician Identification Numbers (UPINs), including SLF000, are no longer permitted.

Additional Resources

Updated: 12.10.15

Two Vantage Way, Nashville, TN 37228 ©2016 CGS Administrators, LLC. All Rights Reserved