Healthcare Providers

Billing & Claims

During this challenging and unprecedented event, CareFirst wants to keep you informed of the benefit updates we are making to ensure our members, your patients, have access to the care they need.

Please note that general guidance appears first on this page, followed by Medicare Advantage-specific guidance at the bottom.

Billing and Submitting Claims for COVID-19 Vaccines

CareFirst members will pay $0 for any authorized COVID-19 vaccine. Providers will be reimbursed by CareFirst for administration of a vaccine. The vaccine is paid for by the federal government. Providers should not submit claims for the cost of the vaccine.

Effective for dates of service on and after June 8, 2021, CareFirst is increasing fees for in-home vaccinations in alignment with the CMS. Professional providers may bill M0201 in addition to existing vaccine administration codes for COVID-19 vaccines given in the home. This increase is designed to promote vaccine accessibility in vulnerable and hard-to-reach populations.

Medical providers should submit claims for vaccine administration using the appropriate codes below. Dental providers should refer to the information under the Dental tab for the appropriate CDT and CPT codes.

ManufacturerFirst Dose Administration CPTSecond Dose Administration CPTThird Dose Administration CPT 
Pfizer 0001A 0002A 0003A
(effective 8/12/21)
Moderna 0011A 0012A 0013A
(effective 8/12/21)
Janssen (Johnson & Johnson) 0031A n/a n/a

Providers who administer a COVID-19 vaccine for a Medicare Advantage member will need to bill Medicare directly for those costs.

Billing and Submitting Commercial Claims for Coronavirus Treatment

As of September 1, 2021, except for monoclonal antibody treatment (see codes in chart below), CareFirst is no longer waiving cost sharing (copays, coinsurance and deductibles) for in-network or out-of-network visits to a provider’s office, lab fees or treatments related to COVID-19 treatment.

Effective for dates of service on and after September 1, providers may collect copays for services related to COVID-19 treatment. This change applies to commercial members. Effective January 1, 2022, this change will also apply to Medicare Advantage members.

Billing for Monoclonal Antibody Infusion

Providers will be reimbursed by CareFirst for administration of the drug. The drug is paid for by the federal government. Providers should not submit claims for the cost of the drug.

Maryland providers: please see the recent Maryland Department of Health expanded authorization of REGEN-COV and fact sheet.

COVID-19 TreatmentDate of ServiceAdministration Code(s) 
Monoclonal Antibody Infusion code (Covered for all qualified in-network providers. Prior authorization is not required).

On or after
November 21, 2020

M0243 (casirivimab and imdevimab)

On or after
November 21, 2020
Q0243 (Injection, casirivimab and imdevimab, 2400 mg)

On or after
February 9, 2021

M0245 (intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring)

On or after
February 9, 2021

Q0245 (injection, bamlanivimab and etesevimab, 2100 mg)

On or after
May 6, 2021
M0244 (Intravenous infusion or subcuteaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence)
On or after
May 6, 2021
M0246 (Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence)
On or after
May 26, 2021
Q0247 (Injection, sotrovimab, 500 mg)
On or after
May 26, 2021
M0247 (Intravenous infusion, sotrovimab, includes infusion and post administration monitoring)

On or after
May 26, 2021

M0248 (Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence)

On or after
June 3, 2021

Q0244 (Injection, casirivimab and imdevimab, 1200 mg)
On or after
July 30, 2021
M0240 (Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses)
On or after
July 30, 2021
M0241 (Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, subsequent repeat doses)

On or after
July 30, 2021

Q0240 (Injection, casirivimab and imdevimab, 600 mg)

On or after
November 10, 2020
through April 16, 2021 (when the FDA revoked emergency use authorization)

HCPCS codes:
M0239 (bamlanivimab-xxxx)

Submitting Commercial Claims for Office Visits, Urgent Care or ER Visits

Submit claims for office visits, urgent care, or ER visits for the purpose of diagnosing or ordering testing for COVID-19 using ICD-10 primary diagnosis code of Z20.828 regardless of the place of service. Use the following ICD-10 reporting codes for billing COVID-19 treatment:

  • Treatment of coronavirus- use code U07.1 as primary diagnosis code
  • Treatment of comorbidity symptoms should be submitted with the appropriate diagnosis code

For cases where there was a concern about a possible exposure to COVID-19, but was ruled out after evaluation, submit claims using ICD-10 primary diagnosis code of Z03.818.

Claims for asymptomatic individuals who are being screened for COVID-19, have no known exposure to the virus, and the test results are either unknown or negative, should be submitted using ICD-10 primary diagnosis code Z11.59.

For more information on claims reporting view the CDC’s ICD-10-CM Official Coding and Reporting Guidelines.

Submitting Testing Claims

We cover Emergency Use Authorization (EUA) approved COVID-19 tests. The chart below provides information for submitting claims for our commercial members.

COVID-19 TestDate of ServiceCode(s) 
Standard Diagnostic COVID-19 Testing

On or after February 4, 2020

HCPCS code U0002

On or after March 13, 2020

CPT 87635

Standard Diagnostic COVID-19 Testing
Combined with Flu A and B

On or after October 6, 2020

HCPCS code 0240U CPT code 87636
Standard Diagnostic COVID-19 Testing Combined with Flu A and B and RSV

On or after October 6, 2020

HCPCS code 0241U CPT code 87637
High Throughput Diagnostic Testing

On or after April 14, 2020

HCPCS codes U0003 or U0004
Serology/Antibody Testing
Antibody tests must be on the EUA list, be ordered by the patient’s provider, be medically necessary and have a high likelihood of impacting clinical decision making.

On or after April 11, 2020

CPT codes 86328 or 86769
Rapid Antigen Testing
Practices must have a Clinical Laboratory improvement Amendments Certificate of Waiver to conduct rapid antigen tests when the test is administered.

On or after June 25, 2020

CPT code 87426
Direct Visual Antigen.

On or after August 18, 2020

CPT code 87811
Proprietary Lab Analysis Diagnostic Testing for Detecting COVID-19.

On or after October 6, 2020

HCPCS code 0225U

Billing for Home Births

Home birth services are covered for our commercial members 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.

Lab Services for Commercial Members

For the duration of this public health emergency, CareFirst has expanded the scope of our contracted lab partners to support access to testing as it becomes available. As part of this expansion, providers and BlueChoice members are not limited to using LabCorp for COVID-19 testing. COVID-19 tests may be sent to any lab contracted with CareFirst authorized to perform the testing, including hospital-based labs. We also cover CPT Proprietary Laboratory Analysis codes 0224U and 0223U.

Billing and Submitting Medicare Advantage Claims for Coronavirus Treatment

CareFirst is waiving cost sharing (copays, coinsurance and deductibles) for in-network or out-of-network visits to a provider’s office for treatments related to COVID-19.

Submit claims (Professional/Facility) with U07.1 (COVID-19) or J12.82 (Pneumonia due to coronavirus disease) as the primary diagnosis.

Cost share will also be waived when certain diagnosis codes for obstetrics, sepsis, or transplant complications are listed as primary with U07.1 or J12.82 as secondary.

Submitting Medicare Advantage Claims for Office Visits, Urgent Care or ER Visits

Submit claims for office visits, urgent care, or ER visits for the purpose of treating COVID-19 using ICD-10 primary diagnosis code of U07.1 regardless of the place of service. J12.82 should be used when treating patients who have pneumonia due to COVID-19.