Healthcare Providers
Telemedicine Guidelines
CareFirst is encouraging members to call their doctor’s office if they have symptoms of the flu, COVID-19 or other contagious conditions. During this public health event, 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.
If the claim is to evaluate a member for coronavirus, use diagnosis code Z20.828 (Exposure to viral disease). If you are treating a member with confirmed coronavirus use diagnosis code B97.29 for dates of service prior to 4/1/20 and diagnosis code U07.1 for dates of service on and after 4/1/20. 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.
Please note, through December 31, CareFirst will waive cost sharing for in-network or out-of-network visits to a provider’s office, including telemedicine, related to diagnosis and treatment of COVID-19. Providers are encouraged not to collect member cost sharing 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. For these purposes we’ve defined telemedicine as a combination of interactive audio and video.
Member-Initiated Phone Consultations
Through December 31, CareFirst is paying for phone consultations provided by physicians and nurse practitioners credentialed in CareFirst’s network for the following specialties: primary care provider, internal medicine, OB/GYN, family practice and pediatrics. CareFirst will pay a $20 flat fee for CPT 99441.* We selected this code 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 recent change in D.C. law for members covered by a D.C. insured product, member-initiated phone calls are covered at $20 (CPT Code 99441), regardless of a provider’s specialty.
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
Through December 31, 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 recent change in D.C. law for members covered by a D.C. insured product, member-initiated phone calls are covered at $20 (CPT Code 99441), regardless of a provider’s specialty.
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 recent change in D.C. law for members covered by a D.C. insured product, member-initiated phone calls are covered at $20 (CPT Code 99441).
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.