Claims Submitted to MACs Using Institutional Formats

10.2.2 - Claims Submitted to MACs Using Institutional Formats (Rev. 11355; Issued:04-14-22; Effective:05-16-22; Implementation:05-16-22) The applicable types of bill acceptable when billing for influenza virus, pneumococcal and COVID-19 vaccines are 012x, 013x, 022x, 023x, 034x, 072x, 075x, 081x, 082x, and 085x. Contractors shall refer to § 10.3.2 for applicable billing requirements for mass immunization. The following revenue codes are used for reporting vaccines and administration of the vaccines for all providers except RHCs and FQHCs. Independent and provider based RHCs and FQHCs follow §10.2.2.2 below when billing for influenza virus, pneumococcal, hepatitis B, and COVID-19 vaccines. Units and HCPCS codes are required with revenue code 0636: Revenue Code Description 0636 Pharmacy, Drugs requiring detailed coding (a) 0771 Preventive Care Services, Vaccine Administration In addition, for the influenza virus vaccine, providers report condition code M1 when roster billing. See roster billing instructions in §10.3 of this chapter. When vaccines are provided to inpatients of a hospital or SNF, they are covered under the vaccine benefit. However, the hospital bills on type of bill 012x using the discharge date of the hospital stay or the date benefits are exhausted. A SNF submits type of bill 022x for its Part A inpatients.