COVID-19 Vaccine and Monoclonal Antibody Therapy Paper Roster Billing Packet

Palmetto GBA has prepared this packet for health care providers who mass-immunize their patients against COVID-19 or administer the Medicare-covered COVID-19 monoclonal antibody infusion therapy. The packet contains instructions on how to submit claims using the roster billing method.

COVID-19_Roster_Billing_Packet.pdf (PDF - 129 KB)
COVID-19_Claim_Form.pdf (PDF - 2 MB)
COVID-19_Monoclonal_Antibody_Roster_Form-JJB.pdf (PDF - 288 KB)
COVID-19_Vaccine_Roster_Form-JJB.pdf (PDF - 287 KB)

Last Updated: 03/01/2021