Carefirst - Covd19

Carefirst Policy - latest update March 23, 2020.


CareFirst amended its Medical Policy on a temporary basis to pay for phone consultations provided by physicians and nurse practitioners credentialed in CareFirst’s network for the following specialties: primary care provider, OB/GYN, family practice and pediatrics.

CareFirst will pay a $20 flat fee for CPT 99441. Use this code for all phone visits, regardless of the amount of time. This is in effect through April 17, 2020. At the end of the 30 days, CareFirst will re-evaluate if the policy should be extended for a longer period of time.

Encouraged the use of telemedicine and virtual sites of care such as CareFirst Video Visit.

  • For telemedicine accessed through a CareFirst Video Visit, copays, coinsurance, and deductibles will be waived for the duration of this public health emergency—including behavioral health, lactation support, nutrition counseling and urgent care services.
  • For other provider sponsored telemedicine, CareFirst will continue to pay providers for those services, but members may be subject to copays, coinsurance or deductibles.
  • For clinician staff of primary care, general practice, internal medicine, pediatrics, OBGYN and associated nurse practitioners, CareFirst will pay for telephone consultations during this public health emergency, with no member out-of-pocket cost.

Options and resources for telemedicine based on your office’s capabilities -

Existing Telemedicine Capability : If your practice has its own telemedicine capability (audio/video), proceed with visits and bill CareFirst as normal with a “GT” or “95” modifier and indicate the Place of Service of “02.” If the claim is to evaluate a member for coronavirus, use diagnosis code Z20.828 (Exposure to viral disease) and member cost sharing will be waived

  • No Telemedicine Capability : If your practice does not have telemedicine capability, please note that 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.

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