CareFirst Changes Coverage Determination for Certain Codes
Our Healthcare Policy department continuously reviews clinical guidance to ensure we are engaged and aligned with the most recent updates. Based on the most recent data, CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) is changing how we process certain codes for skin substitute materials used for the treatment of non-healing wounds and burns.
Effective August 1, 2023, the following codes will be considered Experimental/Investigational, and claims with these codes will be denied:
- A2011 - Supra sdrm, per square centimeter
- A2012 - Suprathel, per square centimeter
- A2013 - Innovamatrix fs, per square centimeter
- A4100 - Skin substitute, fda cleared as a device, not otherwise specified
- Q4238 - Derm-maxx, per square centimeter
What if I don’t agree with the coverage determination?
If you don’t agree with the coverage determination, you may have the option to submit an appeal. You can find more information about submitting an appeal in Chapter 5 of the Medical Provider Manual, as well as in our Corrected Claims, Inquiries and Appeals on-demand training available on our Learning and Engagement Center or directly here.