Member Cost Share Waiver for COVID-19 Treatment Ending

Posted on 2021-06-25
Updated on 2021-07-20 12:23:43

CareFirst is revisiting cost sharing policies enacted at the beginning of the COVID-19 pandemic. Although this change will not be effective until September, we want to ensure providers and members have ample time to prepare.

Effective September 1, 2021, CareFirst will no longer waive cost sharing for COVID-19 treatment. Providers may collect the appropriate member cost share (copay, coinsurance and deductible) for treatment rendered on and after September 1, 2021. This change applies to commercial members, except for members who have fully insured D.C. health benefit coverage. Effective January 1, 2022, this change will also apply to Medicare Advantage members.

In keeping with local and federal requirements, the cost share waiver will remain for the following:

  • Visits (in all settings) associated with diagnostic COVID-19 testing
  • Diagnostic COVID-19 tests
  • FDA-authorized COVID-19 antibody tests

Note: COVID-19 vaccination is not considered treatment and will remain at zero cost share for members.

CareFirst continues to focus on and invest in vaccinations to end the pandemic. In April, we announced an increase to our base fees for COVID-19 vaccination and we have also decided to align with CMS’s decision to increase fees for in-home vaccinations using code M0201. Effective for dates of service on and after June 8, 2021, professional providers may bill M0201 in addition to existing vaccine administration codes. This increase is designed to promote vaccine adoption in our vulnerable populations by incenting providers to vaccinate difficult to reach members.

Providers are encouraged to check eligibility and benefits on CareFirst Direct or by calling the Provider Service number on the back of the member ID card.

To stay up-to-date on COVID-19 policies and benefits updates, visit our Coronavirus Resource Center. You can also read about CareFirst’s full response to COVID-19, and sign our Better Together Vaccination Pledge

We appreciate everything providers are doing to care for our members throughout the pandemic.