Bills Submitted to FIs/AB MACs (Rev. 1586, 10-06-08)

by  Jared Staheli
June 25th, 2015

The applicable types of bills acceptable when billing for influenza virus and pneumococcal vaccines are 12X, 13X, 22X, 23X, 34X, 72X, 75X, 83X and 85X.

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 and hepatitis B 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 in Form Locator (FLs) 24-30 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 the FI on bill type 12X using the discharge date of the hospital stay or the date benefits are exhausted. A SNF submits type of bill 22X for its Part A inpatients.

References:

Bills Submitted to FIs/AB MACs (Rev. 1586, 10-06-08). (2015, June 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/bills-submitted-to-fis-ab-macs-rev-1586-10-06-08-26898.html

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