Healthcare Providers

During this public health emergency, CareFirst is encouraging members to call their doctor’s office to discuss evaluation options. We understand the use of telemedicine is a practical option for members who wish to or should stay home. Therefore, we have temporarily expanded our telemedicine policy. Refer to our coding guidance for all existing and temporarily covered services.

Telemedicine Capability

If your practice has its own telemedicine capability (audio/video), proceed with visits and bill CareFirst as normal with a place of service “02” and refer to this guidance for accepted telemedicine procedure codes and modifiers. Services for diagnosis, consultation or treatment provided through telemedicine must meet all the requirements of a face-to-face consultation or contact between a licensed health care provider and a patient consistent with the provider's scope of practice for services appropriately provided through telemedicine services. Utilization review may be performed. Documentation in the medical record must support the services rendered.

If you are currently not set up to conduct telemedicine, you can use a commercially available platform to conduct telemedicine visits. The Office for Civil Rights (OCR) at the HHS has stated that providers may use commercially available video chat services to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules during the COVID-19 nationwide public health emergency. Guidance and frequently asked questions can be found on their website.

Member-Initiated Phone Consultations

CareFirst is paying a $20.00 flat fee for phone consultations provided by behavioral health providers in CareFirst’s network. Psychiatrists and Nurse Practitioners should use CPT 99441.* Psychologists, Licensed Certified Social Workers and Licensed Professional Counselors should use code 98966. We selected these codes as check-ins for all phone visits, regardless of the amount of time.

* These benefits are covered for our fully insured members. We are also partnering closely with our self-insured customers to implement similar measures. Due to a change in D.C. law for members covered by a D.C. insured product, member-initiated phone calls are covered at $20, regardless of a provider’s specialty. Physicians and Nurse Practitioners should use CPT Codes 99441, 99442 or 99443. Non-physician providers should use CPT codes 98966, 98967 or 98968.

During this public health emergency, CareFirst is encouraging members to call their doctor’s office and utilize telemedicine options when available. We understand the use of telemedicine is a practical option for members who wish to or should stay home. Therefore, we have temporarily expanded our telemedicine policy. Refer to our coding guidance for all existing and temporarily covered services.

Telemedicine Capability

If your practice has its own telemedicine capability (audio/video), proceed with visits and bill CareFirst as normal with a place of service “02” and refer to this guidance for accepted telemedicine procedure codes and modifiers. Services for diagnosis, consultation or treatment provided through telemedicine must meet all the requirements of a face-to-face consultation or contact between a licensed health care provider and a patient consistent with the provider's scope of practice for services appropriately provided through telemedicine services. Utilization review may be performed. Documentation in the medical record must support the services rendered.

If you are currently not set up to conduct telemedicine, you can use a commercially available platform to conduct telemedicine visits. The Office for Civil Rights (OCR) at the HHS has stated that providers may use commercially available video chat services to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules during the COVID-19 nationwide public health emergency. Guidance and frequently asked questions can be found on their website. Phone consultations are not reimbursable.

Member-Initiated Phone Consultations

Due to a change in D.C. law for members covered by a D.C. insured product, member-initiated phone calls are covered at $20, regardless of a provider’s specialty. Physicians and Nurse Practitioners should use CPT Codes 99441, 99442 or 99443. Non-physician providers should use CPT codes 98966, 98967 or 98968.

During this public health emergency, CareFirst is encouraging members to call their dentist’s office and utilize telemedicine options when available. Dentists have been asked to limit their physical encounters to emergencies and urgent dental care only.

We understand the use of telemedicine is a practical option for members who wish to or should stay home. For these purposes, the American Dental Association (ADA) and CareFirst have defined synchronous teledentistry (D9995) as a real time encounter, interactive, with both audio and visual components. The use of asynchronous teledentistry (D9996) will not be a covered encounter when used without subsequent real time audio and visual encounters for emergencies and urgent dental care during this public health crisis.

The ADA has compiled information on how to perform these services and has provided additional guidance on how to bill for teledentistry services. We will not provide a benefit for photographs, streamed or recorded video or any other costs of the actual telemedicine technology. We consider this technology as equivalent to your in-office fixed costs.

Telemedicine Capability

CareFirst’s coverage will be limited to the problem-focused exam and follow up, with D9995 considered inclusive to the telehealth service. If you and your patient determine that an office visit with you is necessary to resolve the problem, the in-person evaluation at your office on the same date of service will be considered inclusive to the telemedicine evaluation completed earlier in the day. One evaluation will be covered per patient per date of service. For problem-focused telemedicine evaluations, please submit the appropriate code, D0140 or D0170 and your usual fee. Add D9995 to identify the synchronous telemedicine encounter and include a brief description of the patient’s emergent problem in the remarks section. CareFirst will pay based on the contracted fees and the patient’s plan design.*

If your practice has its own telemedicine capability (audio/video), proceed with visits and bill CareFirst as normal with a place of service “02” and follow normal billing guidelines for both hard copy and electronic claim submissions. The Office for Civil Rights (OCR) at the HHS has stated that providers may use commercially available and third party video chat services to provide telemedicine without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules during the COVID-19 nationwide public health emergency. Guidance and frequently asked questions can be found on their website.

* These benefits are covered for our fully insured members. We are also partnering closely with our self-insured customers to implement similar measures.

Audio-Only Visits

Audio-only teledentistry is covered when the patient is unable to participate in an audiovisual visit in lieu of an in-person office visit. Dental providers should use D0190 with D9995 for audio-only dental telehealth visits.

CareFirst BlueCross BlueShield Medicare Advantage will cover telemedicine services with in-network primary care providers (PCPs), specialists, behavioral health providers and other selected providers. The same cost share fees that apply to in-person appointments also apply to these services.  Review CMS’ telemedicine guidance for a complete list of covered services.

If you are currently not set up to conduct telemedicine, you can use a commercially available platform to conduct telemedicine visits. The Office for Civil Rights (OCR) at the HHS has stated that providers may use commercially available video chat services to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules during the COVID-19 nationwide public health emergency. Guidance and frequently asked questions can be found on their website.

Audio-only telehealth is covered when a patient is unable to participate in an audio-visual visit in lieu of an in-person office visit. Where required, CareFirst will cover audio-only calls that result in the delivery of a billable, covered healthcare service.

Maryland Preserve Telehealth Access Act

The Maryland Preserve Telehealth Access Act of 2021, effective July 1, 2021 expanded the definition of telehealth to include audio-only calls that result in the delivery of a billable, covered healthcare service.

The mandate expands telehealth coverage to all professional provider types, including dentists, but not all procedures.

Refer to this document for the acceptable audio-only procedure codes/modifiers.

This mandate expires June 30, 2023 and is applicable to patients enrolled in fully insured Maryland benefit plans.

Starting July 1, members receiving care by way of audio-only calls will be subject to the same cost share (e.g., their copay, coinsurance or deductible) as an in-person office visit, where applicable.

Refer to this helpful information to learn how to determine a member’s benefit plan.