Healthcare Providers
Frequently Asked Questions
Have questions about home birth, telemedicine or other policies? Check below for the latest updates.
Effective May 12, 2023, COVID-19 testing is processed according to the member’s benefit contract. Member cost sharing does apply if applicable.
The information below is for historical purposes and is effective until May 12, 2023.
CareFirst covers, with no cost share to the member (including our members enrolled in high deductible health plans), the appropriate diagnostic testing for COVID-19. Beginning January 15, 2022, and for the duration of the Federal Public Health Emergency, over-the-counter tests used for diagnostic purposes that are purchased online or at a store or pharmacy will also be covered.
CareFirst does not provide benefits for COVID-19 testing for surveillance, work or social purposes, which includes but is not limited to testing conducted:
- at the direction of a member’s employer to obtain or maintain employment;
- for the return to school or to participate in school activities (e.g., sports); or
- to participate in recreational activities (e.g., concerts, public events, cruises).
This policy will apply to all CareFirst members except where testing for surveillance, work or social purposes is required by law.
Providers should use code Z02.X - Encounter for Administrative Examination on claims for surveillance, work, or social purposes. However, CareFirst will not cover testing when this code is used except where required by law.
Some large employers may have elected different benefits. For questions regarding a member’s benefits and coverage for COVID-19 testing, please call provider customer service.
Overhead costs, such as PPE, are included as part of a provider’s office visit reimbursement. CareFirst does not provide additional reimbursement for PPE including supplies, materials and additional staff time. Per our participating provider agreements, providers cannot bill CareFirst members for non-covered supplies such as PPE.
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.
In general, all CareFirst members have coverage for telemedicine visits through the provider office or through CloseKnit.
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.
Yes. However, effective May 12, 2023, the video services must be HIPAA compliant.
The information below is for historical purposes:
The Office for Civil Rights (OCR) at HHS recently restated their guidance that allows providers to use commercially available video services, even if they are not HIPAA compliant, to offer telehealth during the public health emergency. CareFirst has aligned with this guidance until further notice.
At this time, there is no authorized monoclonal antibody treatment.
The information below is for historical purposes.
CareFirst covers Monoclonal antibody treatments approved for emergency use authorization when administered by a qualified provider. An outpatient treatment locator maintained by the U.S. Department of Health and Human Services is now available to assist healthcare providers and patients in finding potential locations for treatment with monoclonal antibody therapeutics. Additionally, in Maryland, the health department has opened regional infusion locations across the state. As supply increases, the state will open additional locations.
Maryland Department of Health’s Regional Infusion Centers
This list was updated on 2/3/2021
Region 1
UPMC Western Maryland
Garrett Regional Medical Center
Meritus Medical Center
Region 2
Baltimore City Convention Center
Anne Arundel Medical Center
University of Maryland Upper Chesapeake Health
Region 3
TidalHealth Peninsula Regional
Atlantic General Hospital
Region 4
Southern Maryland Hospital Center
Adventist Takoma Park
Doctors Community Hospital
Effective February 1, 2021 CareFirst will cover remote physiologic monitoring for patients discharged from an inpatient facility or emergency room where a diagnosis of heart failure, chronic hypertension, chronic obstructive pulmonary disease, chronic kidney disease, or COVID-19 is on the claim. Remote patient monitoring must be ordered within 60 days of the patient’s discharge date or emergency room visit and requires a prescription from either the discharging provider or the patient’s primary care or specialty care provider. Detailed information, including a list of diagnoses covered, is available in our Medical Policy Reference Manual, medical policy number 2.01.084 Remote Patient Monitoring.
Effective September 11, 2023, use the billing guidance found on the Billing and Claims tab for administration and vaccination codes.
The information below is for historical purposes.
Unlike childhood vaccinations, the administration codes are unique to the product/manufacturer, so there is no need for a separate product code. Because the drug is provided at no cost, you should only bill CareFirst for the administration.
With COVID-19 codes and guidelines evolving rapidly, we often receive new codes that are immediately effective. To ensure time for our teams to vet, load and test new codes, it is recommended providers wait 30 days to begin billing new COVID-19 codes to avoid any premature denials that would require you to resubmit. We will not add new codes on our Coronavirus Resource Center until they are fully ready for billing. If you have a question about code status, you may also call Provider Service.