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Telemedicine Guidelines

  • Audio-Visual Telehealth
  • Audio-Only Telehealth
  • Behavioral Health
  • Specialists
  • Medicare Advantage

CareFirst is encouraging members to call their doctor’s office if they have symptoms of the flu, COVID-19 or other contagious conditions. 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.

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.

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.

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.

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.

Maryland Preserve Telehealth Access Act

The Maryland legislature passed the Maryland Preserve Telehealth Access Act of 2021, which was effective July 1, 2021.

The Act expands the definition of telehealth to include audio-only calls, which result in the appropriate delivery of a billable, covered health care service.  The mandate expands telehealth coverage to all professional provider types (including dentists), but not all procedures.

Effective July 1, 2021, if you offer audio-only calls, you will be paid for qualifying* audio-only calls at the same payment policy as an in-person office visit for a patient screening, where applicable. This mandate expires June 30, 2025.

Audio-Only Dental Visit Billing Guidelines*

Effective October 1, 2023, CareFirst will only cover audio-only calls where mandated by law. 

Dental providers may submit CDT code D0190 with D9995 (to identify the synchronous telemedicine encounter) and include a brief description of the patient’s emergent problem for audio-only teledentistry. 

We encourage you to verify this code’s specific frequencies and limitations on CareFirst Direct by navigating to the Benefits sidebar to the right on your patient’s Eligibility Summary screen.

One screening will be covered per patient per date of service.

Teledentistry Capability

CareFirst’s coverage will be limited to a 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 problem-focused evaluation will be covered per patient per date of service . For problem-focused teledentistry evaluations, please submit the appropriate code, D0140 or D0170, and your usual fee. Add D9995 to identify the synchronous teledentistry 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 teledentistry 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 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.

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

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.

Effective October 1, 2023, CareFirst will only cover audio-only calls where mandated by law.

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, 2025 and is applicable to patients enrolled in fully insured Maryland benefit plans.

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.

Audio-Only Telehealth Coverage Details

Dental providers—please see updated audio-only telehealth information under the Dentists tab .

CareFirst Coronavirus Provider News and Updates

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  1. CareFirst Video Visit by CareFirst BlueCross BlueShield

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  2. CareFirst Video Visit by CareFirst BlueCross BlueShield

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  3. My Office CareFirst Baltimore Visit

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  4. Member Tools

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VIDEO

  1. Lunch & Learn

  2. CareForPeople- Entry 15

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  5. Carefirst x Orioles Seedy Nutty

  6. CareFirst BlueCross BlueShield breaks down barriers standing in the way of behavioral health

COMMENTS

  1. CareFirst Video Visit

    CareFirst Video Visit has been discontinued and replaced by CloseKnit, a telemedicine platform that offers more services and features for CareFirst members. Learn how to access CloseKnit, the same services as CareFirst Video Visit, and find answers to common questions.

  2. Video Visit

    The cost for your Video Visit varies depending on your benefits, but the cost will be visible to you before you begin your visit. Use CareFirst Video Visit for treatment of non-emergency* health issues such as: Fevers. Ear pain. Cold and flu. Eczema. Sinus infection. Urinary tract infection. Bronchitis.

  3. CareFirst Video Visit

    CareFirst BlueCross BlueShield does not direct the action of participating providers or provide medical advice. Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc.

  4. CareFirst Virtual Care Options

    CareFirst offers several virtual care options that let you meet with credentialed doctors, clinical experts or dedicated care teams through your computer, phone, or tablet. You can also access video visit services with MedStar eVisit, a convenient and secure platform that lets you connect with your primary care provider anytime, anywhere.

  5. CareFirst Video Visit

    CareFirst Video Visit lets you see a board-certified doctor 24/7/365 on your smartphone, tablet or computer for treatment of common health issues such as fevers, ear pain, cold and flu, and more. You can choose the pharmacy, pay the cost, and get a prescription if appropriate. The cost varies depending on your benefits, but you can see the cost before you begin your visit.

  6. Telemedicine Services

    Learn how to bill and code telemedicine services for coronavirus and other conditions with CareFirst, a health insurance provider in Maryland, Washington, D.C. and Virginia. Find out the coverage types, payment notes and coding guidance for audio-video and audio-only telemedicine visits.

  7. Included with Every Plan

    CareFirst offers a variety of member programs, tools and resources to help you live your best life, get more from your plan and save on healthcare costs. Video visit is one of the benefits included with every plan, along with behavioral health and addiction support, CloseKnit virtual care practice, and more.

  8. CareFirst Video Visit

    See a board-certified doctor on any device, 24/7 with CareFirst BCBS Video Visit

  9. PDF CareFirst Video Visit

    Video Visit lets you connect with a doctor or other provider for common health issues such as allergies, flu, cold or mental health. You can also get care for other needs such as therapy, nutrition or breastfeeding support from a licensed and credentialed provider. Register today and schedule your visit online or through the app.

  10. PDF CareFirst Video Visit: How to Register Online and Get Started

    CareFirst Video Visit: How to Download the App and Get Started Download: Download the CareFirst Video Visit mobile app for iOS/Android from the app store. The icon below is the CareFirst Video Visit app. Get Started: To get started, follow steps 2-8 listed above. Please note the screen shots will look slightly different through the app vs online.

  11. PDF CareFirst Video Visit

    CareFirst Video Visit. iPad/iPhone guide. This document will guide you on setting up and joining Video Visits using an iPad/iPhone. Note: Apple iOS version 7 or higher is required. If you need technical assistance, please call Technical Support at 844-839-9231, Monday - Friday, 7 a.m. - 6 p.m. (Eastern Time).

  12. PDF CareFirst Video Visit

    Use Video Visit when you're facing uncomplicated, non-emergency issues such as allergies, a sinus infection, a cold or the flu and more. Video Visit doctors will provide you a consultation, diagnosis and even prescriptions (when available and appropriate). They are all U.S. board-certified, licensed and credentialed medical professionals.

  13. PDF CareFirst Video Visit

    In the case of a life-threatening emergency, you should always call 911 or your local emergency services. CareFirst Video Visit does not replace these services. CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare

  14. Video Visit is a cost-effective option for providing ...

    CareFirst Video Visit: An easy-to-use, convenient and cost-effective option for providing quality care. May 13, 2016 - Colleague, CareFirst's telemedicine capability, Video Visit, is a tool that's been designed to offer you and your patients another option for care.

  15. PDF Member Information

    Member Information | CareFirst BlueCross BlueShield

  16. PDF CareFirst Video Visit: How to Register and Get Started

    CareFirst BlueCross BlueShield, CareFirst BlueChoice, Inc., CareFirst Diversified Benefits and all of their corporate affiliates (CareFirst) comply with applicable federal civil rights laws and do not discriminate on the . basis of race, color, national origin, age, disability or sex. CareFirst does not exclude people or treat them

  17. PDF CareFirst Video Visit

    CareFirst Video Visit is intended for the treatment of uncomplicated, non-emergency** health concerns including, but not limited to: n Bronchitis n Cough/sore throat n Sinus infection n Diarrhea n Fever n Pinkeye n Cold/flu n Respiratory infection Video Visit doctors provide consultation, diagnosis and even prescriptions (when available and ...

  18. CareFirst Video Visit 12+

    CareFirst Video Visit The doctor will see you now. See a doctor anytime on your phone, tablet or computer. CareFirst BlueCross BlueShield Video Visit allows you and your family members to connect with doctors whenever and wherever you want. Board certified doctors with an average of 10-15 years in practice are available 24/7 without an appointment!

  19. Sign Up

    CareFirst BlueCross BlueShield (CareFirst) Video Visit allows you to securely connect with a doctor whenever and wherever you want on your smartphone, tablet or computer. Urgent Care Video Visits are available 24/7/365, and you also have the option to schedule visits with licensed professionals for other services. The cost for your visit varies ...

  20. PDF 2022 Healthcare Benefit Options

    CareFirst Video Visit Video Visit securely connects you with a doctor, day or night, through your smartphone, tablet or computer. You can also schedule visits for other needs such as therapy or counseling, nutrition or breastfeeding. Visit carefirstvideovisit.com to learn more. 24-Hour Nurse Advice Line

  21. When You Need Care Frequently Asked Questions

    CareFirst Video Visit is great when you're on the road for vacation or work. Video Visit is available in all 50 states. Select the state you're in under My Location and you'll only see doctors licensed to treat you in that state. When using the app, you can choose to update your current state based on mobile geolocation, making it faster ...

  22. PDF Member Quick Guide

    CareFirst Video Visit Get no-cost treatment for common health concerns like flu and pink eye 24/7 without an appointment. Consult with a board-certified doctor on your smartphone, tablet or computer. You can also schedule visits for therapy/psychiatry, diet/nutrition and breastfeeding support services. These services have a fee and

  23. Get Ready For Online Conversations

    You can still have a visit but may experience lower quality video or sound. Your connection speed doesn't support video visits You can still have a visit using chat and phone, but video quality will be poor. ... CareFirst BlueCross BlueShield Medicare Advantage is the business name of CareFirst Advantage, Inc., an independent licensee of the ...