Billing for Flu, Pneumococcal, and COVID-19 Vaccines

For flu, pneumococcal, and COVID-19 vaccines furnished on or after July 1, 2023, to patients staying in a Medicare Part A-covered skilled nursing facility (SNF), immunizers can no longer bill Medicare directly.

Typical SNF consolidated billing regulations are in place, which require SNFs to bill for all services furnished to patients in a Medicare-covered SNF stay, including vaccines.

If you give the COVID-19, flu, and/or pneumococcal shot to groups of individuals (like people who live in a retirement community) you’re considered a mass immunizer and you may use a roster bill, traditional claim form, or 837P.

More information:

• SNF: Enforcement Discretion Relating to Certain Pharmacy Billing webpage
• SNF Consolidated Billing webpage
• Flu Shot webpage
• Pneumococcal Shot & Administration
• Section 20.4 Medicare Claims processing Manual, Chapter 6
• Medicare Part D Vaccines fact sheet