Healthcare Providers

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.

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.

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.

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.