Healthcare Providers

Frequently Asked Questions

Have questions about home birth, telemedicine or other policies? Check below for the latest updates.

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CareFirst only requires prior authorization on high dollar equipment for our HMO business.

Timeframes are determined by our regulatory bodies based on jurisdiction.

CareFirst does not require prior authorization for emergency ground ambulance transportation.

CareFirst does not require prior authorization for emergency air transport to the closest facility capable of caring for the unstable patient. All unstable COVID-19 patients requiring air transport should be treated as emergent and will not require authorization as long as it is to the closest capable facility.

Per our Global Maternity Care Medical Policy (4.0.1.66A), home birth services are covered when the member has maternity coverage. When billing for home deliveries, use place of service code 12 and refer to the provider guidelines in the Global Maternity Care Medical Policy (4.0.1.66A) for procedure coding guidance.
Yes, as long as they have an arrangement with a physician to be available if needed. If needed, the physician could provide care in the home or in the hospital.
In general, all CareFirst members have coverage for telemedicine visits through the provider office or through CareFirst Video Visit.
The CareFirst Professional Provider Manual outlines the telemedicine policy. Additionally, more information can be found in CareFirst’s Telemedicine Medical policy (2.01.072A). If you have further questions, please reach out to your Provider Relations Representative or Practice Consultant for assistance.
CareFirst Video Visit is provided for members who do not have a relationship with a physician in the community. CareFirst prefers that members contact a health care provider in the community, if they have one.

FEP benefit information can be found on the FEP website.

In accordance with the Families First Coronavirus Response Act, CareFirst is covering the antibody test for SARs-CoV-2. To be covered by CareFirst the test should:

  • Be on the EUA list
  • Be ordered by a physician or other authorized provider
  • Be medically necessary
  • Have a high likelihood of impacting clinical decision making

The tests will not indicate whether an individual has an active infection of COVID-19. Additionally as recently stated in the CDC Guidelines, the following remains uncertain:

  • Whether individuals with antibodies are protected against reinfection with SARS-CoV-2;
  • What level of antibodies is needed to confer protection; and,
  • The duration of any protection that might exist.

CareFirst is in agreement with CDC guidance that serology tests should not be used to inform important policy decisions, such as opening schools or requiring employees to return to work. The current role for these tests is in the surveillance of communities to track where the virus has been and where it is heading. We anticipate further clarification and direction as to how to use these tests and newer tests in the future.

There are limited clinical scenarios mentioned in the CDC guidelines where serology testing could have a role: 1) to support diagnosis in persons who present to care 9 to 14 days after illness onset and 2) to help establish the diagnosis of multisystem inflammatory syndrome in children.

Antibody testing is not designed to be a diagnostic test and has limited value in the management and treatment of an individual patient.

  • For an in-office visit, bill with procedure code 99211 if there is no physician or Qualified Health Physician involved; or 99212 or greater if a physician or Qualified Health Professional is involved.
  • If no in-office visit or E&M service is provided with the specimen collection, you can bill 99001 to be reimbursed separately.

Use Z11.59 or other relevant diagnosis to ensure any member cost-sharing is waived.

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