Healthcare Providers
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, billing and claims information for Medicare Advantage members coming soon.
Billing and Submitting 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, lab fees or treatments related to COVID-19. Though CareFirst is waiving out-of-pocket costs, members may experience balance billing from out-of-network providers.
Providers should not collect copays for these services. If a member does owe a copay or coinsurance after the claim is processed, you can bill the member as you do for all other claims.
Billing for Home Births
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.
Submitting 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.
| COVID-19 Test | Date of Service | Code(s) |
|---|---|---|
| Standard Diagnostic COVID-19 Testing |
On or after February 4, 2020 On or after March 13, 2020 |
HCPCS code U0002 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 |
| Monocolonal Antibody Infusion code (prior authorization is not required) |
On or after November 10, 2020 |
HCPCS codes: M0243 (casirivimab and imdevimab) |
Lab Services
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.