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.
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 (184.108.40.206A) 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. To submit claims:
- For Standard Diagnostic Testing, use Healthcare Common Procedure Coding System (HCPCS) procedure code U0002 effective for dates of service on or after February 4, 2020 or Current Procedural Terminology (CPT) code 87635 effective for dates of service on or after March 13, 2020.
- For High Throughput Diagnostic Testing, use HCPCS procedure codes U0003 or U0004. These codes are valid for dates of service on or after April 14, 2020.
- For Serology/Antibody Testing, use CPT codes 86328 or 86769. These codes are valid for dates of service on or after April 11, 2020. 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.
- For Rapid Antigen Testing, use CPT code 87426 on or after June 25, 2020. Note that practices must have a Clinical Laboratory Improvement Amendments Certificate of Waiver to conduct rapid antigen tests when the test is administered.
Refer to FAQs for billing information on specimen collection.
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 0223.