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

Published 02/20/2023

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)

COVID-19_Claim_Form.pdf (PDF)

COVID-19_Monoclonal_Antibody_Roster_Form-RR.pdf (PDF)

COVID-19_Vaccine_Roster_Form-RR.pdf (PDF)

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