Claims Submitted to Carriers/AB MACs (Rev. 1586, 10-06-08)

by  Jared Staheli
June 25th, 2015

Medicare does not require that the influenza virus vaccine be administered under a physician’s order or supervision. Effective for claims with dates of service on or after July 1, 2000, Medicare does not require that pneumococcal vaccinations be administered under a physician’s order or supervision. Medicare still requires that the hepatitis B vaccine be administered under a physician’s order with supervision. As a physician order is still required for claims for hepatitis B vaccinations, information on the ordering and/or referring physician must be entered on the claim.

A. Reporting Specialty Code/Place of Service (POS) to CWF Specialty

Contractors use specialty code 60 (Public Health or Welfare Agencies (Federal, State, and Local)) for Public Health Service Clinics (PHCs).

Contractors use specialty code 73 (Mass Immunization Roster Billers) for centralized billers and specialty code 87 for pharmacists (all other suppliers (drug stores, department stores)).

Entities and individuals other than PHCs and pharmacists use the CMS specialty code that best defines their provider type. A list of specialty codes can be found in chapter 26. The CMS specialty code 99 (Unknown Physician Specialty) is acceptable where no other code fits.

Place of Service (POS)

State or local PHCs use POS code 71 (State or Local Public Health Clinic). POS 71 is not used for individual offices/entities other than PHCs (e.g., a mobile unit that is nonPHC affiliated should use POS 99). Preprinted Form CMS-1500s (08-05) used for simplified roster billing should show POS 60 (Mass Immunization Center) regardless of the site where vaccines are given (e.g., a PHC or physician’s office that roster claims should use POS 60). Individuals/entities administering influenza virus and pneumococcal vaccinations in a mass immunization setting (including centralized flu billers), regardless of the site where vaccines are given, should use POS 60 for roster claims, paper claims, and electronically filed claims.

Normal POS codes should be used in other situations.

Providers use POS 99 (Other Unlisted Facility) if no other POS code applies.

References:

Claims Submitted to Carriers/AB MACs (Rev. 1586, 10-06-08). (2015, June 25). Find-A-Code Articles. Retrieved from https://www.findacode.com/articles/claims-submitted-to-carriers-ab-macs-rev-1586-10-06-08-26904.html

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