Healthcare Providers

Billing & Claims

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 that general guidance appears first on this page, followed by Medicare Advantage-specific guidance at the bottom.

As new codes are released, please allow 30 days before billing the new codes to allow for us to have them configured in our systems appropriately.

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CareFirst members will pay $0 for any authorized COVID-19 vaccine. Providers will be reimbursed by CareFirst for administration of a vaccine. Effective September 11, 2023, the vaccine is no longer paid for by the federal government. Providers should submit claims for the cost of the vaccine.

Effective for dates of service on and after June 8, 2021, CareFirst is increasing fees for in-home vaccinations in alignment with the CMS. Professional providers may bill M0201 in addition to existing vaccine administration codes for COVID-19 vaccines given in the home. This increase is designed to promote vaccine accessibility in vulnerable and hard-to-reach populations.

Medical providers should submit claims for vaccine administration using the appropriate codes below. Dental providers should refer to the information under the Dental tab for the appropriate CDT and CPT codes.

New Pfizer COVID-19 vaccination codes effective September 11, 2023

Code Age Range
91318 6 months through 4 years
91319 5 years through 11 years
91320 12 years and older

New Moderna COVID-19 vaccination codes effective September 11, 2023

Code Age Range
91321 6 months through 11 years
91322 12 years and older

Novavax COVID-19 Code 91304 remains in effect.

To report COVID-19 vaccine administration, use CPT code 90480.

Adults

(Termination date for all of the following codes - November 1, 2023. This information is for historical purposes.)

Manufacturer First Dose Administration CPT Second Dose Administration CPT Third Dose Administration CPT  Booster Administration CPT
Pfizer BioNTech 0001A 0002A 0003A
(effective 8/12/21)
0004A
(effective 10/20/21)
Moderna Vaccine/Spikevax
COVID-19 Vaccine (Spikevax)
0011A 0012A 0013A
(effective 8/12/21)
0064A
(effective 10/20/21)
Janssen (Johnson & Johnson) 0031A n/a n/a 0034A
(effective 10/20/21)
Novavax 0041A 0042A n/a n/a
Pfizer 0051A 0052A 0053A 0054A
Moderna n/a n/a n/a 0094A

Pediatrics

(Termination date for all of the following codes - November 1, 2023. This information is for historical  purposes.)

Manufacturer First Dose Administration CPT Second Dose Administration CPT Third Dose Administration CPT  Booster Administration CPT Notes
Pfizer BioNTech 0071A
(effective 10/29/21)
0072A
(effective 10/29/21)
0073A
(effective 1/1/22)
0074A
(effective 5/17/22)
5 months through 11 years of age
Pfizer BioNTech 0081A
(effective 06/17/22)
0082A
(effective 6/17/22)

0083A
(effective 6/17/22)

n/a 6 months through 4 years of age
Moderna 0111A
(effective 06/17/22)
0112A
(effective 6/17/22)
0113A
(effective 6/17/22)
n/a 6 months through 5 years of age
Moderna 0091A
(effective 06/17/22)
0092A
(effective 6/17/22)
0093A
(effective 6/17/22)
n/a 6 months through 11 years of age

COVID-19 Vaccine Administration Fees for Medicare Advantage–For dates of service prior to January 1, 2022, providers who administer a COVID-19 vaccine for a Medicare Advantage member should bill Medicare directly for the administration fee. Beginning January 1, 2022, providers should bill CareFirst for vaccine administration fees for Medicare Advantage members.

As of September 1, 2021, CareFirst is no longer 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 treatment. This does not apply to monoclonal antibody treatment (see codes in chart below).

Effective for dates of service on and after September 1, providers may collect copays for services related to COVID-19 treatment. This change applies to commercial members. Effective January 1, 2022, this change will also apply to Medicare Advantage members.

Providers will be reimbursed by CareFirst for administration of the drug. The drug is paid for by the federal government. Providers should not submit claims for the cost of the drug.

Maryland providers: please see the recent Maryland Department of Health expanded authorization of REGEN-COV and fact sheet.

COVID-19 Treatment Date of Service Administration Code(s) 
Monoclonal Antibody Infusion code (Covered for all qualified in-network providers. Prior authorization is not required).

On or after
November 21, 2020

M0243 (casirivimab and imdevimab)

On or after
November 21, 2020
Q0243 (Injection, casirivimab and imdevimab, 2400 mg)

On or after
February 9, 2021

M0245 (intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring)

On or after
February 9, 2021

Q0245 (injection, bamlanivimab and etesevimab, 2100 mg)

On or after
May 6, 2021
M0244 (Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence)
On or after
May 6, 2021
M0246 (Intravenous infusion, bamlanivimab and etesevimab, includes infusion and post administration monitoring in the home or residence)
On or after
May 26, 2021
Q0247 (Injection, sotrovimab, 500 mg)
On or after
May 26, 2021
M0247 (Intravenous infusion, sotrovimab, includes infusion and post administration monitoring)

On or after
May 26, 2021

M0248 (Intravenous infusion, sotrovimab, includes infusion and post administration monitoring in the home or residence)
On or after
June 3, 2021
Q0244 (Injection, casirivimab and imdevimab, 1200 mg)
On or after
June 24, 2021
M0249 (Intravenous infusion, tocilizumab) includes infusion and post administration monitoring, first dose
On or after
June 24, 2021
M0250 (Intravenous infusion, tocilizumab) includes infusion and post administration monitoring, second dose
On or after
July 30, 2021
M0240 (Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring, subsequent repeat doses)
On or after
July 30, 2021
M0241 (Intravenous infusion or subcutaneous injection, casirivimab and imdevimab includes infusion or injection, and post administration monitoring in the home or residence, subsequent repeat doses)

On or after
July 30, 2021

Q0240 (Injection, casirivimab and imdevimab, 600 mg)

On or after
November 10, 2020
through April 16, 2021 (when the FDA revoked emergency use authorization)

HCPCS codes:
M0239 (bamlanivimab-xxxx)

In view of supply shortages for current COVID-19 therapeutic treatments, effective January 12, 2022, CareFirst is covering a three-day hospital outpatient course of VEKLURY (Remdesivir) infusion treatment.

  • No prior authorization is required.
  • Normal cost sharing and benefit limitations apply.
  • CMS has created HCPS code J0248 for Remdesivir when delivered in an outpatient setting.

This coverage applies to all CareFirst members: Commercial, Federal Employee Program, Medicaid, Dual Eligible Special Needs and Medicare Advantage.

Providers in other outpatient settings who wish to offer Remdesivir should reach out to their Provider Contracting Representative to discuss further.

Read the NIH COVID-19 Treatment Guidelines Panel’s Statement on Therapies for High-Risk, Non-Hospitalized Patients with Mild to Moderate COVID-19.

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.

Effective May 12, 2023, claims for COVID-19 testing will be processed and paid according to the member’s contract.

The information below is for historical purposes and was effective until May 12, 2023.

CareFirst covers, with no cost share to the member (including our members enrolled in high deductible health plans), the appropriate medically necessary diagnostic testing for COVID-19. Tests must be FDA authorized or approved and ordered by an authorized healthcare professional. The chart below provides information for submitting claims for our commercial members.

For information on how we cover surveillance testing, please review this FAQ

COVID-19 Test Date of Service Code(s) 
Standard Diagnostic COVID-19 Testing

On or after February 4, 2020

HCPCS code U0002

On or after March 13, 2020

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
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
Detection of the presence and temporal evolution of the adaptive immune response after COVID-19 infection

On or after
September 8, 2020

86413
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
Neutralizing antibody

On or after August 10, 2020

86408-screen
86409-titer
Multiplex viral pathogen panel using immunoassay technique for SARS-CoV-2 testing along with influenza A and
influenza B

On or after
November 10, 2020

87428

Home birth services are covered for our commercial members 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.

Effective May 12, 2023, for utilization of in-network laboratories, members will have to follow the requirements of their contract. BlueChoice members are required to utilize LabCorp.

The information below is for historical purposes prior to May 12, 2023.

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.

Effective May 12, 2023, Medicare Advantage member’s claims are processed in accordance with their contract. Cost share waiver no longer applies.

The information below is for historical purposes prior to May 12, 2023.

CareFirst is waiving cost sharing (copays, coinsurance and deductibles) for in-network or out-of-network visits to a provider’s office for treatments related to COVID-19.

Submit claims (Professional/Facility) with U07.1 (COVID-19) or J12.82 (Pneumonia due to coronavirus disease) as the primary diagnosis.

Cost share will also be waived when certain diagnosis codes for obstetrics, sepsis, or transplant complications are listed as primary with U07.1 or J12.82 as secondary.

Submit claims for office visits, urgent care, or ER visits for the purpose of treating COVID-19 using ICD-10 primary diagnosis code of U07.1 regardless of the place of service. J12.82 should be used when treating patients who have pneumonia due to COVID-19.

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